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Published on: March 15, 2022
Intra-arterial nicardipine versus verapamil during transradial access coronary catheterization
Keshav Patel1, Melissa Duckett2, Mladen I Vidovich2
1Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States of America.
Insights
Intra-arterial nicardipine causes less discomfort than verapamil during transradial access (TRA) cardiac catheterization. Both vasodilators effectively prevent radial artery spasm (RAS) with low incidence.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Access
Background:
- Intra-arterial (IA) vasodilators are crucial for preventing radial artery spasm (RAS) during transradial access (TRA).
- Current American Heart Association (AHA) guidelines recommend IA verapamil, diltiazem, nicardipine, or nitroglycerin.
- Direct comparative data on the efficacy and patient tolerability of verapamil versus nicardipine for RAS prevention is limited.
Purpose of the Study:
- To compare patient-reported discomfort and pain associated with IA nicardipine versus IA verapamil administration.
- To evaluate the efficacy of nicardipine and verapamil in preventing RAS during TRA procedures.
Main Methods:
- A prospective, single-blinded randomized clinical trial was conducted.
- Patients received either 400 mcg of IA nicardipine (n=26) or 5 mg of IA verapamil (n=29).
- Patient discomfort and pain were assessed using the Visual Analogue Scale (VAS) pre- and post-IA administration.
Main Results:
- A statistically significant difference in mean VAS score change was observed, with a lower increase in the nicardipine group (0.88) compared to the verapamil group (4.81) (p < 0.0001).
- The overall incidence of RAS was low (5.5%) and not significantly different between groups (p = 0.465).
- RAS occurred in 7.7% of the nicardipine group (1 case required strategy change) and 3.4% of the verapamil group (no strategy change).
Conclusions:
- IA nicardipine administration results in significantly less patient discomfort and pain compared to IA verapamil during TRA procedures.
- Both nicardipine and verapamil demonstrate a low incidence of RAS, suggesting comparable efficacy in prevention.
- Nicardipine may be a preferred agent for IA administration in TRA due to improved patient tolerability.
Introduction:
Intra-arterial (IA) vasodilators are recommended during transradial access (TRA) to prevent radial artery spasm (RAS). The American Heart Association (AHA) recommends either IA verapamil, diltiazem, nicardipine, or nitroglycerin to prevent RAS. To our knowledge, the efficacy of RAS prevention and patient tolerability of verapamil and nicardipine has not been directly compared in a randomized fashion.
Methods:
We conducted a prospective, single-blinded randomized clinical trial comparing the discomfort experienced by patients receiving either 400 μg of IA nicardipine (n = 26) or 5 mg of IA verapamil (n = 29). Patient discomfort and/or pain was assessed using the Visual Analogue Scale (VAS) both before and after IA administration of nicardipine or verapamil.
Results:
There was a statistically significant difference in mean change in VAS scores between the 2 groups, with an average increase in VAS score of 0.88 in the nicardipine group and 4.81 in the verapamil group (p < 0.0001). The overall rate of RAS was low in our study (5.5 %) with no significant difference in RAS incidence between the 2 groups (p = 0.465). The nicardipine group had 2 RAS cases (7.7 %), with 1 requiring a change in strategy (3.8 %). The verapamil group had 1 RAS case (3.4 %) that did not require a change in strategy.
Conclusion:
In this trial, we showed that nicardipine causes significantly less discomfort and pain compared to verapamil during IA administration for TRA cardiac catheterization.
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