Darius H, Nixdorff U, Zander J, Rupprecht H J, Erbel R, Meyer J
Department of Medicine II, Johannes Gutenberg University, Mainz, Germany.
Agents Actions Suppl. 1992;37:305-11. doi: 10.1007/978-3-0348-7262-1_42.
Ciprostene, a chemically stable prostacyclin analog was studied for its effects on restenosis in patients with coronary artery disease undergoing therapeutic percutaneous transluminal coronary angioplasty (PTCA). In a double-blind, randomized trial 32 patients were randomized to receive either ciprostene or the respective placebo. The infusion started intracoronarily at a rate of 40 ng/kg/min 20 min before introduction of the balloon catheter into the coronary artery. Thereafter infusion was continued intravenously for 36 hours at a rate of 120 ng/kg/min and a tapering off period until 48 hours. The quantitative analyses of the degree of coronary artery stenoses on the angiographic films before PTCA, after PTCA and after 6 month of follow-up was performed in 24 patients available. In patients receiving placebo (n = 12) coronary artery stenoses was 81 +/- 3% before PTCA and was reduced to 34 +/- 3% by angioplasty. At the 6 month follow up angiography stenoses diameter was measured as 63 +/- 8%, being not significantly different from the % stenoses before PTCA. In contrast, coronary artery stenoses in patients receiving ciprostene (n = 12) measured 83 +/- 3% before PTCA, 31 +/- 4% after PTCA and 55 +/- 9% at 6 month, being still significantly different from pre-PTCA value (P less than 0.05). When patients were characterized according to their clinical status, these differences were accounted for by patients with unstable angina receiving ciprostene. Ciprostene seems to reduce restenosis 6 month after coronary angioplasty in patients with unstable angina. The infusion rate of 40 ng/kg/min i.c. followed by 120 ng/kg/min i.v. was tolerated well, although the incidence of catheter associated bleeding was increased.
西前列烯是一种化学性质稳定的前列环素类似物，研究了其对接受治疗性经皮腔内冠状动脉成形术（PTCA）的冠心病患者再狭窄的影响。在一项双盲、随机试验中，32例患者被随机分为接受西前列烯或相应安慰剂组。在将球囊导管插入冠状动脉前20分钟，以40 ng/kg/min的速率开始冠状动脉内输注。此后，以120 ng/kg/min的速率静脉持续输注36小时，并逐渐减量直至48小时。对24例可用患者在PTCA前、PTCA后及随访6个月后的冠状动脉造影胶片上冠状动脉狭窄程度进行了定量分析。接受安慰剂的患者（n = 12）在PTCA前冠状动脉狭窄为81±3%，经血管成形术后降至34±3%。在6个月随访血管造影时，狭窄直径测量为63±8%，与PTCA前的狭窄百分比无显著差异。相比之下，接受西前列烯的患者（n = 12）在PTCA前冠状动脉狭窄为83±3%，PTCA后为31±4%，6个月时为55±9%，仍与PTCA前值有显著差异（P < 0.05）。根据临床状况对患者进行分类时，这些差异是由接受西前列烯的不稳定型心绞痛患者造成的。西前列烯似乎可降低不稳定型心绞痛患者冠状动脉成形术后6个月的再狭窄率。冠状动脉内输注速率为40 ng/kg/min，随后静脉输注速率为120 ng/kg/min，耐受性良好，尽管导管相关出血的发生率有所增加。
