Effects of diltiazem on myocardial ischemia in patients with coronary artery disease.
OBJECTIVE
To evaluate the effect of diltiazem on the characteristics of ischemic episodes detected by Holter monitoring in a group of patients with proven coronary artery disease.


METHODS
Department of Cardiology, Santa Marta Hospital, Lisbon.


METHODS
Eleven selected out-patients, aged 48 to 79 years, with transient ST-segmental depression on Holter monitoring and proven coronary artery disease, were submitted to a double-blind crossover placebo controlled study, during hospitalization. The total ischemic burden of each patient and an analysis of ischemic episodes were evaluated before and during the drug/placebo phase trial. Three groups of ischemic episodes were considered: group I constituted by 66 episodes found on basal Holter recording; group II by 28 episodes detected during placebo trial and group III by 12 episodes detected during diltiazem trial.


RESULTS
A reduction of the number of ischemic episodes was predominantly observed with the diltiazem administration. Statistically significant differences were observed between basal and placebo groups and especially between basal and diltiazem groups concerning the mean maximum ST-segment depression (2.17 vs 1.80; p = 0.030 and 2.17 vs 1.54; p = 0.0091). Significant differences were also obtained between the above mentioned groups concerning the heart rate variation from the onset of ST-segment depression to its maximum depression (13.5 vs 9.69; p = 0.023 and 13.5 vs 2.91; p = 0.01) and from two minutes before the onset of ST-segment depression to its maximum depression (21.2 vs 12.67; p = 0.012 and 21.2 vs 8.75 p = 0.016).


CONCLUSIONS
Diltiazem seems to reduce the number of ischemic episodes in patients with coronary artery disease, during hospitalization. The study of its effects on the characteristics of ischemia requires further investigation with a greater number of patients. The limitations of the present study, described in the discussion, must be taken into account in future pharmacological investigations with Holter monitoring.
Department of Cardiology, Santa Marta Hospital, Lisbon.
E
E
Antunes
J
J
Serra
R
R
Ferreira
C
C
Catarino
N
N
da Silva
M
M
de Oliveira
J
J
Quininha
A S
AS
Prates
R
R
Gracias
J A
JA
Rato
D000368:Aged; D003327:Coronary Disease / Q000150:complications; D004110:Diltiazem / Q000627:therapeutic use*; D004311:Double-Blind Method; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D014463:Ultrasonography
D004110:Diltiazem