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Published on: February 16, 2011
Safety of Calcium-Channel Blockers During Radial Cardiac Catheterization in Patients With Acute Myocardial Infarction
Barbara D Lawson1, M Zubair Khan, Richard H Cooke
1Virginia Commonwealth University Pauley Heart Center, 1200 East Broad Street, P.O. Box 980036, Richmond, VA 23298-0036 USA. barbara.lawson@vcuhealth.org.
Insights
Calcium-channel blockers (CCBs) are safe for patients undergoing radial artery catheterization, even those with ST-segment elevation myocardial infarction (STEMI) or heart failure (HF). This study found no significant adverse effects in these high-risk populations.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- Radial artery catheterization is increasingly used globally but less so in the US due to vasospasm concerns.
- Intra-arterial calcium-channel blockers (CCBs) are used to prevent spasms but their safety in high-risk patients is unclear.
- ST-segment elevation myocardial infarction (STEMI) and systolic heart failure (HF) patients may have contraindications for CCBs.
Purpose of the Study:
- To assess the safety of intra-arterial CCBs during radial artery catheterization.
- To evaluate CCB safety in patients with STEMI or HF, who typically have contraindications.
Main Methods:
- Prospective evaluation of consecutive STEMI and HF patients undergoing cardiac catheterization over one year.
- All patients received CCB post-sheath insertion via the radial approach.
- Primary outcome: change in blood pressure post-CCB; secondary outcome: procedural outcomes.
Main Results:
- 184 patients (54 STEMI, 129 HF) were included.
- Verapamil administration caused significant drops in systolic and diastolic blood pressure (P<.001) but no heart rate change.
- 15.7% of patients had SBP decrease >20 mm Hg, none requiring vasopressors.
Conclusions:
- Intra-arterial CCBs are safely tolerated by patients with STEMI or HF during radial catheterization.
- This finding supports the use of CCBs to prevent vasospasm in these patient groups.
Objectives:
The aim of this study was to evaluate the safety of calcium-channel blockers (CCBs) during radial artery catheterization in two populations with a contraindication to their use.
Background:
Cardiac catheterization performed via the radial approach has become increasingly common worldwide, but adoption has been slow in the United States. One possible explanation is concern over radial artery vasospasm, which can complicate procedures. Spasmolytic drugs, typically intra-arterial CCBs, are used to prevent spasm, but their safety is not well established in high-risk populations, such as those with ST-segment elevation myocardial infarction (STEMI) or systolic heart failure (HF), in which CCB may be contraindicated.
Methods:
Consecutive STEMI and HF patients undergoing cardiac catheterization over a 1-year period were prospectively evaluated. All operators in our laboratory use the radial approach unless contraindicated. All patients received CCB immediately after sheath insertion. The primary outcome of interest was change in blood pressure immediately after CCB. Procedural outcomes were also evaluated.
Results:
A total of 184 patients were included in the study (54 with STEMI and 129 with HF). There was a significant drop in systolic blood pressure (SBP) and diastolic blood pressure (DBP) following verapamil administration (P<.001 for both), but no change in HR (P>.99). SBP decreased more than 20 mm Hg in 15.7% of patients, none of whom required initiation of vasopressors. In regression analysis, only baseline SBP correlated significantly with the change in blood pressure.
Conclusions:
Patients with STEMI or HF can safely tolerate intra-arterial CCB during radial catheterization.
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