Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 12, Number 5, October 2021, pages 286-292

Heme Effects in Lowering Patient Discomfort in Radial Artery Verapamil Injection

**Table 1.** Baseline Characteristics of Patients
Characteristics	Saline + verapamil (n = 100)	Heme + verapamil (n = 103)	P-value
Variables are expressed as no. (%) or mean ± standard deviation. P < 0.05 indicates statistically significant difference between the groups. STEMI: ST elevation myocardial infarction; NSTEMI: non-ST elevation myocardial infarction; UA: unstable angina; BMI: body mass index.
Age (years)	65.05 ± 10.68	64.68 ± 10.63	0.80
Male sex	59 (59.0%)	63 (61.2%)	0.75
Medical history
Diabetes mellitus	36 (36.0%)	38 (36.9%)	0.90
Hypertension	84 (84.0%)	79 (76.7%)	0.19
Hyperlipidemia	76 (76.0%)	77 (74.8%)	0.84
Current smoker	44 (44.0%)	38 (36.9%)	0.30
Chronic systolic heart failure	19 (19.0%)	14 (13.6%)	0.30
Coronary artery disease	37 (37.0%)	38 (36.9%)	0.99
Peripheral vascular disease	7 (7.0%)	3 (2.9%)	0.21
Chronic kidney disease	10 (10%)	13 (12.6%)	0.82
Clinical presentation
STEMI	0 (0.0%)	1 (1.0%)	1.00
NSTEMI	1 (1.0%)	3 (2.9%)	0.62
UA	8 (8.0%)	18 (17.5%)	0.04
BMI (kg/m²)	29.87 (11.10)	31.05 (8.30)	0.50

Table 1. Baseline Characteristics of Patients

Characteristics

Saline + verapamil (n = 100)

Heme + verapamil (n = 103)

P-value

Variables are expressed as no. (%) or mean ± standard deviation. P < 0.05 indicates statistically significant difference between the groups. STEMI: ST elevation myocardial infarction; NSTEMI: non-ST elevation myocardial infarction; UA: unstable angina; BMI: body mass index.

Age (years)

65.05 ± 10.68

64.68 ± 10.63

0.80

Male sex

59 (59.0%)

63 (61.2%)

0.75

Medical history

Diabetes mellitus

36 (36.0%)

38 (36.9%)

0.90

Hypertension

84 (84.0%)

79 (76.7%)

0.19

Hyperlipidemia

76 (76.0%)

77 (74.8%)

0.84

Current smoker

44 (44.0%)

38 (36.9%)

0.30

Chronic systolic heart failure

19 (19.0%)

14 (13.6%)

0.30

Coronary artery disease

37 (37.0%)

38 (36.9%)

0.99

Peripheral vascular disease

7 (7.0%)

3 (2.9%)

0.21

Chronic kidney disease

10 (10%)

13 (12.6%)

0.82

Clinical presentation

STEMI

0 (0.0%)

1 (1.0%)

1.00

NSTEMI

1 (1.0%)

3 (2.9%)

0.62

8 (8.0%)

18 (17.5%)

0.04

BMI (kg/m²)

29.87 (11.10)

31.05 (8.30)

0.50

**Table 2.** Chronic Medications by Patient Groups
Medications	Saline + verapamil (n = 100)	Heme + verapamil (n = 103)	P-value
Variables are expressed as no. (%). P < 0.05 indicates statistically significant difference between the groups. CCB: calcium channel blocker; ACEI: angiotensin-converting-enzyme inhibitors; ARB: angiotensin II receptor blockers.
Aspirin	63 (63.0%)	57 (55.3%)	0.27
Clopidogrel	9 (9.0%)	10 (9.7%)	0.86
Prasugrel	2 (2.0%)	5 (4.9%)	0.45
Ticagrelor	2 (2.0%)	3 (2.9%)	1.00
Warfarin	10 (10.0%)	7 (6.8%)	0.41
Apixaban	5 (5.0%)	7 (6.8%)	0.59
Rivaroxaban	2 (2.0%)	4 (3.9%)	0.68
Endoxaban	1 (1.0%)	0 (0.0%)	0.49
Beta-blocker	61 (61.0%)	64 (62.1%)	0.87
CCB	13 (13.0%)	26 (25.2%)	0.027
ACEI/ARB	51 (51.0%)	49 (47.6%)	0.63
Statin	63 (63.0%)	65 (63.1%)	0.99

Table 2. Chronic Medications by Patient Groups

Medications

Saline + verapamil (n = 100)

Heme + verapamil (n = 103)

P-value

Variables are expressed as no. (%). P < 0.05 indicates statistically significant difference between the groups. CCB: calcium channel blocker; ACEI: angiotensin-converting-enzyme inhibitors; ARB: angiotensin II receptor blockers.

Aspirin

63 (63.0%)

57 (55.3%)

0.27

Clopidogrel

9 (9.0%)

10 (9.7%)

0.86

Prasugrel

2 (2.0%)

5 (4.9%)

0.45

Ticagrelor

2 (2.0%)

3 (2.9%)

1.00

Warfarin

10 (10.0%)

7 (6.8%)

0.41

Apixaban

5 (5.0%)

7 (6.8%)

0.59

Rivaroxaban

2 (2.0%)

4 (3.9%)

0.68

Endoxaban

1 (1.0%)

0 (0.0%)

0.49

Beta-blocker

61 (61.0%)

64 (62.1%)

0.87

CCB

13 (13.0%)

26 (25.2%)

0.027

ACEI/ARB

51 (51.0%)

49 (47.6%)

0.63

Statin

63 (63.0%)

65 (63.1%)

0.99

**Table 3.** Procedural Data by Patient Groups
Variables	Saline + verapamil (n = 100)	Heme + verapamil (n = 103)	P-value
Variables are expressed as no. (%) or mean ± standard deviation. P < 0.05 indicates statistically significant difference between the groups. PCI: percutaneous coronary intervention.
Ultrasound used	12 (12.0%)	11 (10.7%)	0.77
PCI	12 (12.0%)	18 (17.5%)	0.27
Nitro (µg)	230.0 ± 87.5	217 ± 100	0.59
Verapamil (mL)	2.34 ± 0.83	2.61 ± 0.79	0.02
Lidocaine (mL)	1.4 ± 1.6	1.3 ± 1.43	0.58
Number of sticks	1.54 ± 1.007	1.71 ± 1.0	0.77

Table 3. Procedural Data by Patient Groups

Variables

Saline + verapamil (n = 100)

Heme + verapamil (n = 103)

P-value

Variables are expressed as no. (%) or mean ± standard deviation. P < 0.05 indicates statistically significant difference between the groups. PCI: percutaneous coronary intervention.

Ultrasound used

12 (12.0%)

11 (10.7%)

0.77

PCI

12 (12.0%)

18 (17.5%)

0.27

Nitro (µg)

230.0 ± 87.5

217 ± 100

0.59

Verapamil (mL)

2.34 ± 0.83

2.61 ± 0.79

0.02

Lidocaine (mL)

1.4 ± 1.6

1.3 ± 1.43

0.58

Number of sticks

1.54 ± 1.007

1.71 ± 1.0

0.77

**Table 4.** Comparison of Independent Groups on Primary and Secondary Endpoints
Outcomes	Saline + verapamil (n = 100)	Heme + verapamil (n = 103)	P-value
Variables are expressed as no. (%) or mean ± standard deviation. P < 0.05 indicates statistically significant difference between the groups.
Injection pain score	3.48 ± 3.01	2.83 ± 3.18	0.15
1-h pain score	0.80 ± 1.78	1.0 ± 2.31	0.48
Pre-versed (mg)	1.5 ± 1.2	2.4 ± 2.1	0.016
Pre-fentanyl (µg)	50.65 ± 50.0	53.23 ± 52.12	0.60
Pre-benadryl (mg)	33.25 ± 23.58	29.85 ± 24.52	0.32
Total versed (mg)	2.75 ± 2.38	3.0 ± 2.0	0.08
Total fentanyl (µg)	89.67 ± 55.31	93.45 ± 55.39	0.61
Total benadryl (mg)	33.81 ± 23.51	29 ± 24.56	0.15
Total procedure time (min)	21.5 ± 21.0	24.0 ± 20.0	0.53
Vasospasm	3 (3.0%)	0 (0.0%)	0.12
Hematoma	1 (1.0%)	1 (1.0%)	1.00

Table 4. Comparison of Independent Groups on Primary and Secondary Endpoints

Outcomes

Saline + verapamil (n = 100)

Heme + verapamil (n = 103)

P-value

Variables are expressed as no. (%) or mean ± standard deviation. P < 0.05 indicates statistically significant difference between the groups.

Injection pain score

3.48 ± 3.01

2.83 ± 3.18

0.15

1-h pain score

0.80 ± 1.78

1.0 ± 2.31

0.48

Pre-versed (mg)

1.5 ± 1.2

2.4 ± 2.1

0.016

Pre-fentanyl (µg)

50.65 ± 50.0

53.23 ± 52.12

0.60

Pre-benadryl (mg)

33.25 ± 23.58

29.85 ± 24.52

0.32

Total versed (mg)

2.75 ± 2.38

3.0 ± 2.0

0.08

Total fentanyl (µg)

89.67 ± 55.31

93.45 ± 55.39

0.61

Total benadryl (mg)

33.81 ± 23.51

29 ± 24.56

0.15

Total procedure time (min)

21.5 ± 21.0

24.0 ± 20.0

0.53

Vasospasm

3 (3.0%)

0 (0.0%)

0.12

Hematoma

1 (1.0%)

1.00