Medizinische Klinik

, Volume 93, Issue 10, pp 579–584 | Cite as

Einfluß einer intrakoronaren Dipyridamol-Applikation auf die Inzidenz der Restenose nach PTCA

Eine prospektiv randomisierte Untersuchung
  • Ulrich E. Heidland
  • Waldemar J. Klimek
  • Christoph J. Michel
  • Matthias P. Heintzen
  • Bodo E. Strauer
Originalarbeit

Zusammenfassung

□ Hintegrund

Trotz zunehmender Etablierung der interventionellen Kardiologie stellt die Entwicklung einer Restenose nach PTCA ein bis dato ungelöstes Problem dar, welches in 30 bis 50% der Fälle auftritt. Das thrombozytäre Funktionssystem spielt in der Pathogenese der Restenose eine zentrale Rolle. Dipyridamol bewirkt durch Inhibition der thrombozytären Phosphodiesterase und Verhinderung des, Adenosinabbaues eine Thrombozytenaggregationshemmung.

□ Patienten und Methodik

In der vorliegenden Studie wurde erstmals untersucht, ob durch vorausgehende intrakoronare Applikation von Dipyridamol eine Reduktion der Inzidenz der angioraphischen und klinischen Restenose mit der Notwendigkeit einer erneuten Intervention resultiert. Hierzu wurde bei 763 Interventionen eine Randomisierung bezüglich konventioneller Therapie (Heparin 15 000 IE, Acetylsalicylsäure 500 mg i. v.) oder additiver intrakoronarer Applikation von Dipyridamol (0,5 mg/kg Körpergewicht) vorgenommen. Entsprechend der Randomisierung wurde bei 375 Interventionen (58 Interventionen bei Frauen, Alter 59,6±9,6 Jahre 57 Interventionen bei akutem Koronargefäßsyndrom) mittels Dipyridamol und bei 388 Dilatationen (61 Interventionen bei Frauen, Alter 60,5±8,7 Jahre; 47 Interventionen bei akutem Koronargefäßsyndrom) konservativ verfahren.

□ Ergebnis

Im Vergleich zu konventionell therapierten Patienten (Restenoserate 43,0%) zeigte sich nach Dipyridamol-Applikation eine Reduktion der angiographischen Restenoserate auf 36,8% sowie der klinischen Reinterventionsrate um 15,5%, wobei die statistische Signifikanz jeweils verfehlt wurde. Als ursächlich für diese tendenziell positive Beeinflussung ließ sich eine statistisch signifikant höhere verbliebene Lumenzunahme („net gain”) nach Dipyridamol bei Verlaufskoronarangiographie nachweisen.

□ Schlußfolgerung

Die Inzidenz der angiographischen und klinischen Restenose läßt sich durch Dipyridamol nicht signifikant beeinflussen, wobei sich allerdings ein Trend in Richtung eines günstigeren Langzeitverlaufs ergab.

Schlüsselwörter

PTCA Dipyridamol Thrombozytenaggregation Angiographische und klinische Restenose 

Influence of intracoronary dipyridamole on the incidence of restenosis following PTCA — A prospectively randomised investigation

Abstract

□ Background

Restenosis after PTCA remains a serious long-term complication of balloon angioplasty occurring in 30 to 50% of patients. Platelets play a crucial role in the pathogenesis of restenosis following PTCA. Dipyridamole has been shown to inhibit platelet aggregation in humans. Its action as an antithrombotic drug can be attributed to different mechanisms including inhibition of platelet phosphodiesterase and inhibition of the cellular uptake of adenosine.

□ Patients and Methods

The purpose of the following study was to investigate the effect of an intracoronary infusion of dipyridamole on the incidence of angiographic and clinical restenosis. In 763 balloon angioplasties patients were randomly allocated to receive either conventional pretreatment (heparin 15000 IE, aspirin 500 mg i. v.) or an additional intracoronary infusion of dipyridamole (0,5 mg/kg body weight). Conventional pretreatment was performed in 388 interventions (61 interventions in women, age 60.5±8.7 years; 47 interventions for acute coronary syndromes); in 375 interventions additional, intracoronary dipyridamole was infused (58 interventions in women, age = 59.6±9.6 years; 57 interventions for acute coronary syndromes).

□ Results

As compared to conventional pretreatment intracoronary dipyridamole application was associated with a reduction in angiographic restenosis from 43.0% to 36.8% and a reduction of target vessel revascularisation by 15.5% but failed to reach statistical significance. These results were due to an increase in net gain following dipyridamole application.

□ Conclusion

Intracoronary pretreatment with dipyridamole prior to PTCA fails to reduce the incidence of angiographic restenosis and target vessel revascularisation significantly. However, a moderate improvement of long-term follow-up can be achieved.

Key Words

PTCA Dipyridamole Platelet aggregation Angiographic and clinical restenosis 

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Copyright information

© Urban & Vogel 1998

Authors and Affiliations

  • Ulrich E. Heidland
    • 1
  • Waldemar J. Klimek
    • 1
  • Christoph J. Michel
    • 1
  • Matthias P. Heintzen
    • 1
  • Bodo E. Strauer
    • 1
  1. 1.Medizinische Klinik und Poliklinik BHeinrich-Heine-Universität DüsseldorfDüsseldorf

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