title: Antiischemic effect of intracoronary diltiazem on myocardial ischemia during PTCA.
abstract: 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 3 mg, 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%, all P < 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.
authors.affiliation: Division of Cardiology, National Cardiovascular Center, Osaka, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Saito
authors.forename: H
authors.initials: H
authors.lastname: Nonogi
authors.forename: Y
authors.initials: Y
authors.lastname: Goto
authors.forename: A
authors.initials: A
authors.lastname: Itoh
authors.forename: S
authors.initials: S
authors.lastname: Daikoku
authors.forename: S
authors.initials: S
authors.lastname: Miyazaki
authors.forename: K
authors.initials: K
authors.lastname: Haze
mesh_terms: D000787:Angina Pectoris / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D002121:Calcium Channel Blockers / Q000008:administration & dosage* / Q000627:therapeutic use; D003327:Coronary Disease / Q000628:therapy; D003331:Coronary Vessels; D004110:Diltiazem / Q000008:administration & dosage* / Q000627:therapeutic use; D004311:Double-Blind Method; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D015428:Myocardial Reperfusion Injury / Q000209:etiology / Q000517:prevention & control*; D013997:Time Factors
chemical_list: D002121:Calcium Channel Blockers; D004110:Diltiazem