Nitroglycerin plus diltiazem versus nitroglycerin alone for spasm prophylaxis with transradial approach

The aim of this study was to compare the efficacy of nitroglycerin and diltiazem versus nitroglycerin alone in preventing radial artery spasm (RAS) during transradial coronary procedures.

Spasm after transradial access decreases procedural success. Multiple spasmolytics are used to prevent spasm. Individual efficacy of these agents is not conclusively established.

One hundred and fifty patients undergoing coronary procedures through radial artery were enrolled and divided into two groups of 75 patients each. Patients in Group A received 200 μg nitroglycerin plus 2.5 mg diltiazem intra-arterially, and group B patients received 200 μg nitroglycerin plus placebo (saline). Blood pressure (BP) and heart rate (HR) were recorded at baseline and for 5 minutes after cocktail was given. Clinical signs of RAS, such as pain and resistance during catheter maneuver, were recorded in both groups during the procedure.

Systolic and diastolic BP decreased significantly in Group A compared to Group B after cocktail was given (P<.001 and P<.022, respectively). There were no significant changes of HR in either group. There was no significant difference in the incidence of clinical RAS between Group A (diltiazem plus nitroglycerin) versus Group B (nitroglycerin alone) (5% vs 7%; P=1.000). Furthermore, we found higher incidence of local burning pain in the forearm in patients that receive intra-arterial diltiazem plus nitroglycerin compared to nitroglycerin alone (21% vs 9%; P=.041).

Diltiazem plus nitroglycerin showed no advantage compared to nitroglycerin alone in prevention of RAS in transradial approach.