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Antiischemic effect of intracoronary diltiazem on myocardial ischemia during PTCA

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Summary

To evaluate the effect of intracoronary diltiazem on myocardial ischemia during percutaneous transluminal coronary angioplasty (PTCA), 38 patients were randomly assigned to receive inactive placebo (n = 19; group C) or a low dose (1 mg,n = 10; group D1), or a high dose (2 or 3mg,n = 9; group D2) of diltiazem in a double-blind manner. The agent was administered directly into the coronary artery via a balloon catheter following a control balloon inflation. Chest pain score (maximum, 10) and the magnitude of ischemic ST elevation on standard and intracoronary electrocardiograms (ECGs) during a balloon inflation were assessed in the control and posttreatment periods. After the administration of diltiazem, the chest pain score was significantly decreased in group D1 (control: 5.1 ± 3.6, posttreatment: 3.8 ± 3.1,P < 0.01) and group D2 (3.4 ± 2.5 vs 2.5 ± 2.0,P < 0.01), but not in group C (4.1 ± 3.1 vs 3.7 ± 3.3, difference not significant). The magnitude of ST elevation relative to the control on standard and intracoronary ECGs was significantly smaller in groups D1 and D2 than in group C (standard ECG; D1: 51.8 ± 10.6% of control, D2: 41.6 ± 28.7% vs C: 93.3 ± 15.6% and intracoronary ECG; D1: 47.1 ± 11.7% of control, D2: 27.5 ± 26.9% vs C: 94.6 ± 29.3%, allP < 0.01). Although systolic blood pressure decreased slightly in groups D1 and D2, there was no significant correlation between the change in ST elevation and the change in the rate-pressure product. Pretreatment with a small dose of intracoronary diltiazem attenuated myocardial ischemia during PTCA and this pretreatment may enable us to perform balloon inflation for a longer period.

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Author notes

  1. Katsumi Saito

    Present address: Division of Cardiology, The Heart Institute of Japan, Tokyo Women's Medical College, 8-1 Kawada-cho, Shinjuku-ku, 162, Tokyo, Japan

Authors and Affiliations

  1. Division of Cardiology, National Cardiovascular Center, 5-7-1 Fujishirodai, 565, Suita, Osaka, Japan

    Katsumi Saito, Hiroshi Nonogi, Yoichi Goto, Akira Itoh, Satoshi Daikoku, Shunichi Miyazaki & Kazuo Haze

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  1. Katsumi Saito
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  2. Hiroshi Nonogi
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  6. Shunichi Miyazaki
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  7. Kazuo Haze
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Saito, K., Nonogi, H., Goto, Y. et al. Antiischemic effect of intracoronary diltiazem on myocardial ischemia during PTCA. Heart Vessels 11, 92–99 (1996). https://doi.org/10.1007/BF01744509

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  • DOI: https://doi.org/10.1007/BF01744509

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