Intracoronary dipyridamole reduces the incidence of abrupt vessel closure following PTCA: a prospective randomised trial

Objectives-To investigate the effect of intracoronary dipyridamole on the i ncidence of abrupt vessel closure, myocardial infarction, necessity for byp ass grafting, and death following percutaneous transluminal coronary angiop lasty (PTCA). Patients-Patients were randomly allocated to receive either conventional pr etreatment (heparin 15 000 IU and aspirin 500 mg intravenously) or addition al intracoronary dipyridamole (0.5 mg/kg bodyweight). Dipyridamole was admi nistered in 550 PTCA procedures (455 interventions in men, mean (SD) age 59 .2 (8.4) years; 74 acute coronary syndromes), while conventional pretreatme nt was administered in 544 interventions (444 interventions in men 58.3 (7. 9) years old; 81 acute coronary syndromes). In 53 interventions bail out st enting was performed for threatened abrupt vessel closure. Results-Intracoronary dipyridamole significantly reduced the incidence of a brupt vessel closure (odds ratio 0.42. 95% confidence interval (CI) 0.22 to 0.79). While abrupt vessel closure occurred in 6.1% of interventions follo wing conventional pretreatment, dipyridamole reduced the incidence to 2.5%. Restricting the analysis to balloon angioplasty, this reduction was observ ed in patients with stable angina (odds ratio 0.49, 95% CI 0.23 to 0.96) as well as in those with acute coronary syndromes (odds ratio 0.29, 95% CI 0. 09 to 0.87). Reduction of secondary end points in the dipyridamole treated patients failed to reach significance in the PTCA group. Conclusions-Intracoronary dipyridamole before PTCA reduces the incidence of abrupt vessel closure following PTCA for stable angina and acute coronary syndromes.