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Effects of sumatriptan and eletriptan on diseased epicardial coronary arteries

  • Pharmacodynamics
  • Published:
European Journal of Clinical Pharmacology Aims and scope Submit manuscript

Abstract

Background: Triptans are contraindicated in patients with known or suspected coronary artery disease (CAD); however, few studies have evaluated triptans in patients with obstructive CAD to quantify the vasoconstrictive effect on diseased coronary vessels.

Methods: Patients undergoing percutaneous transluminal coronary angioplasty for symptomatic single-vessel CAD were randomised to one of three parallel cohorts to receive (1) 6 mg intravenously (IV) infused eletriptan plus subcutaneous (SC) placebo, (2) IV infused placebo plus 6 mg SC sumatriptan or (3) IV infused placebo plus SC placebo, as simultaneous administrations in a double-blind manner. Serial arteriograms, hemodynamic indices, electrocardiography and triptan plasma concentrations were obtained.

Results:. Fifteen minutes after triptan challenge, median (95% confidence interval) changes in coronary artery diameter (CADM) at the focal point of the stenosed segment were: dilation of 2.6% (−5.0, 11.4), eletriptan 6 mg IV (n=18); constriction of 6.8% (−12.6, 0.4), sumatriptan 6 mg SC (n=17), and constriction of 4.5% (−7.0, 7.9), placebo (n=10). One patient had angiographic evidence of a new thrombus at the stenosis site, necessitating termination of study infusion and successful stenting of the lesion. There was no correlation between effects on CADM and triptan concentration, or between hemodynamic or electrocardiograph changes and the presence (n=13) or absence (n=33) of chest pain.

Conclusions: Triptans had very little effect on diseased epicardial coronary arteries in a small group of angina sufferers with established CAD. Results should be interpreted cautiously since there may be instances where even modest triptan-associated epicardial constriction is sufficient to precipitate myocardial ischemia in patients with severe obstructive CAD.

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Acknowledgements

This study was supported by a grant from Pfizer Inc. Chris Newman conceptualised the study, assisted in trial design, conducted the trial, analysed the trial results and co-wrote the manuscript. Ian Starkey conducted the trial and assisted in analysing the trial results. Nigel Buller conducted the trial and assisted in analysing the trial results. Ricardo Seabra-Gomes conducted the trial and assisted in analysing the trial results. Simon Kirby assisted in trial design and analysed the trial results. Jayasena Hettiarachchi conceptualised the study, obtained funding, assisted in trial design, analysed the trial results and co-wrote the manuscript. David Cumberland conceptualised the study, assisted in trial design, conducted the trial, analysed the trial results and co-wrote the manuscript. William Hillis conceptualised the study, assisted in trial design, conducted the trial, analysed the trial results and co-wrote the manuscript. The authors would like to acknowledge the editorial assistance of Dr. Edward Schweizer and Thomson Gardiner-Caldwell London in the preparation of this manuscript.

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Authors and Affiliations

  1. Division of Clinical Sciences (North), Cardiovascular Research Unit, University of Sheffield, Sheffield, S5 7AU, UK

    Christopher M. H. Newman

  2. Department of Cardiology, Western General Hospital, Edinburgh, UK

    Ian Starkey

  3. Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK

    Nigel Buller

  4. Department of Cardiology, Hospital Santa Cruz, Carnaxide, Portugal

    Ricardo Seabra-Gomes

  5. Pfizer Inc., Sandwich, UK

    Simon Kirby

  6. Pfizer Inc., New York, NY, USA

    Jayasena Hettiarachchi

  7. Department of Cardiology, Northern General Hospital, Sheffield, UK

    David Cumberland

  8. Western Infirmary, Glasgow, UK

    William S. Hillis

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  1. Christopher M. H. Newman
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Correspondence to Christopher M. H. Newman.

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Newman, C.M.H., Starkey, I., Buller, N. et al. Effects of sumatriptan and eletriptan on diseased epicardial coronary arteries. Eur J Clin Pharmacol 61, 733–742 (2005). https://doi.org/10.1007/s00228-005-0988-4

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  • DOI: https://doi.org/10.1007/s00228-005-0988-4

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