Rauch B, Neumann J, Richardt G, Kranzhöfer R, Barth R, Zimmermann R, Koch H P, Tillmanns H, Schömig A
1. Innere Medizin III, Medizinische Klinik, Universität Heidelberg, Federal Republic of Germany.
Drugs. 1991;42 Suppl 1:31-6. doi: 10.2165/00003495-199100421-00007.
This report summarises selected preliminary results from an ongoing study designed to investigate the effect of the calcium antagonist gallopamil on myocardial ischaemia during percutaneous transluminal coronary angioplasty (PTCA). To date, 12 adult males with coronary artery disease and significant proximal stenosis of the left anterior descending coronary artery (LAD) have been randomly assigned to gallopamil or placebo under double-blind conditions. Patients with recent myocardial infarction, apparent collateralisation of the LAD, myocardial failure, sinoatrial or atrioventricular block, severe hepatic disease or renal failure were excluded from the study. PTCA was performed using at least 2 balloon inflations, each of 2 minutes' duration. Gallopamil 0.4 mg or placebo (normal saline) were administered during the 10-minute interval between the 2 inflations. Blood samples were taken simultaneously from the coronary sinus and the femoral artery before and immediately after each inflation. Lactate concentration and the relative amount of activated neutrophils were selected for trend analysis. Furthermore, ECG changes were analysed by calculating the sum of the absolute ST-segment deviations (80 msec after J point, maximal T deviation) of leads I, II, III, V2, V4 and V6. In the presence of gallopamil, the degree of ST-segment/T-wave changes induced by balloon inflation was reduced. Additionally, gallopamil attenuated myocardial lactate release and appeared to prevent the increase in activated neutrophils observed during control inflations. These preliminary results suggest a beneficial effect from intracoronary administration of gallopamil during PTCA, achieved by attenuation of the ischaemic reaction during coronary occlusion.
本报告总结了一项正在进行的研究的部分初步结果，该研究旨在调查钙拮抗剂加洛帕米在经皮腔内冠状动脉成形术（PTCA）期间对心肌缺血的影响。迄今为止，12名患有冠状动脉疾病且左前降支冠状动脉（LAD）近端严重狭窄的成年男性在双盲条件下被随机分配至加洛帕米组或安慰剂组。近期发生心肌梗死、LAD明显侧支循环、心肌衰竭、窦房结或房室传导阻滞、严重肝病或肾衰竭的患者被排除在研究之外。PTCA至少进行2次球囊扩张，每次持续2分钟。在两次扩张之间的10分钟间隔内给予加洛帕米0.4mg或安慰剂（生理盐水）。在每次扩张前及扩张后立即同时从冠状窦和股动脉采集血样。选择乳酸浓度和活化中性粒细胞的相对数量进行趋势分析。此外，通过计算导联I、II、III、V2、V4和V6的绝对ST段偏移（J点后80毫秒，最大T波偏移）之和来分析心电图变化。在使用加洛帕米的情况下，球囊扩张引起的ST段/T波变化程度降低。此外，加洛帕米减轻了心肌乳酸释放，并且似乎阻止了在对照扩张期间观察到的活化中性粒细胞增加。这些初步结果表明，在PTCA期间冠状动脉内给予加洛帕米具有有益作用，这是通过减轻冠状动脉闭塞期间的缺血反应实现的。
