Lewis B S, Halon D A, Merdler A, Makhoul N, Afriat S, Schneeweiss A
Department of Cardiology, Lady Davis Carmel Hospital, Haifa, Israel.
Eur Heart J. 1992 Nov;13(11):1534-9. doi: 10.1093/oxfordjournals.eurheartj.a060097.
The effect of intracoronary isosorbide dinitrate on provoked myocardial ischaemia during percutaneous transluminal coronary angioplasty (PTCA) was studied in 60 patients who had at least 1 mm electrocardiographic (ECG) ST segment deviation during a 70 s control balloon inflation period. Isosorbide dinitrate (dose 1 mg, 2 mg or 3 mg) or placebo (saline) was administered by slow intracoronary injection, and the ST segment changes recorded again during an identical dilatation period 2-4 min later. Following injection of isosorbide dinitrate, the severity of ST segment deviation decreased (1 mg -31 +/- 30%, P = 0.03; 2 mg -51 +/- 35%, P = 0.0001; 3 mg -36 +/- 32%, P = 0.002) during coronary balloon inflation, and the time until onset of 1 mm ST deviation was prolonged (1 mg +79 +/- 137%, P = 0.06; 2 mg +85 +/- 87%, P = 0.02; 3 mg +78 +/- 109%, P = 0.02). With the 3 mg dose, the time to maximum ECG change increased (+37 +/- 87%, P = 0.02). In the placebo group, there was a small decrease in the severity of ST segment deviation in patients receiving placebo (-23 +/- 32%, P = 0.03), but no change in the time to its onset or in the time to maximum ST deviation. Isosorbide dinitrate did not alter heart rate, systolic arterial pressure or the rate-pressure product at maximum ST segment change, implying that when isosorbide was administered by direct intracoronary injection, a direct cardiac effect was responsible for the major anti-ischaemic effect of the drug.(ABSTRACT TRUNCATED AT 250 WORDS)
对60例在70秒的对照球囊充盈期至少有1毫米心电图（ECG）ST段偏移的患者，研究了冠状动脉内注射硝酸异山梨酯对经皮腔内冠状动脉成形术（PTCA）期间诱发心肌缺血的影响。通过冠状动脉内缓慢注射给予硝酸异山梨酯（剂量1毫克、2毫克或3毫克）或安慰剂（生理盐水），并在2 - 4分钟后的相同扩张期再次记录ST段变化。注射硝酸异山梨酯后，冠状动脉球囊充盈期间ST段偏移的严重程度降低（1毫克 -31±30%，P = 0.03；2毫克 -51±35%，P = 0.0001；3毫克 -36±32%，P = 0.002），并且出现1毫米ST段偏移的时间延长（1毫克 +79±137%，P = 0.06；2毫克 +85±87%，P = 0.02；3毫克 +78±109%，P = 0.02）。使用3毫克剂量时，达到最大ECG变化的时间增加（+37±87%，P = 0.02）。在安慰剂组中，接受安慰剂的患者ST段偏移严重程度略有降低（-23±32%，P = 0.03），但其出现时间或最大ST段偏移时间无变化。硝酸异山梨酯在最大ST段变化时未改变心率、收缩压或心率 - 压力乘积，这意味着当通过直接冠状动脉内注射给予硝酸异山梨酯时，药物的主要抗缺血作用是由直接心脏效应引起的。（摘要截断于250字）
