Iñiguez Romo A, Macaya Miquel C, Hernández Antolín R, Casado Larre J, Alfonso Manterola F, Goicolea Ruigómez J, Zarco Gutiérrez P
Servicio de Exploración Cardiopulmonar, Hospital Universitario San Carlos, Madrid.
Rev Esp Cardiol. 1991 Jun-Jul;44(6):366-74.
The incidence of restenosis remains the same as initially reported (30%) and no therapeutic approach has reduced its appearance. Platelets-induced smooth muscle cell proliferation probably play a preponderant role in the pathogenesis of restenosis. The aim of this study was to evaluate the effects of ticlopidine (250 mg/day) on restenosis rate after single lesion coronary angioplasty. One hundred seventy nine consecutive patients were prospectively included in this study and were assigned to ticlopidine (group T, n = 91) or to a control group (n = 88) in an alternative fashion. Age (60 +/- 10 vs 58 +/- 9 years), gender (87% vs 87% male), treatment, coronary risk factors, lesion morphology, stenosis severity pre- and postangioplasty, type of vessel, collateral circulation, and left ventricular ejection fraction, were similar in the T and control groups, respectively. Unstable angina was more frequently found in group T patients (81% vs 65%, p less than 0.01). A late angiographic follow-up (7 +/- 2 months after angioplasty) revealed restenosis (greater than 50% luminal narrowing) in 26 patients (28%) in group T and in 21 patients (24%) in the control group (NS). At that time, 88% and 98% of patients without restenosis vs 35% and 48% of patients with restenosis were asymptomatic in the T and control groups, respectively. An exercise test prior to the late control angiogram was abnormal (angina and/or ST segment depression) in 77% and 73% of patients with restenosis in T and control groups, respectively. Thus, in our experience, ticlopidine at a dosage of 250 mg/day was unable to reduce restenosis rate after single lesion coronary angioplasty.
再狭窄的发生率仍与最初报道的相同（30%），且尚无治疗方法能减少其出现。血小板诱导的平滑肌细胞增殖可能在再狭窄的发病机制中起主要作用。本研究的目的是评估噻氯匹定（250毫克/天）对单处病变冠状动脉血管成形术后再狭窄率的影响。179例连续患者被前瞻性纳入本研究，并交替分配至噻氯匹定组（T组，n = 91）或对照组（n = 88）。T组和对照组的年龄（60±10岁对58±9岁）、性别（男性分别为87%对87%）、治疗、冠状动脉危险因素、病变形态、血管成形术前和术后的狭窄严重程度、血管类型、侧支循环以及左心室射血分数相似。T组患者中不稳定型心绞痛更为常见（81%对65%，p<0.01）。血管造影术的晚期随访（血管成形术后7±2个月）显示，T组26例患者（28%）出现再狭窄（管腔狭窄>50%），对照组21例患者（24%）出现再狭窄（无显著性差异）。此时，T组和对照组中无再狭窄的患者分别有88%和98%无症状，而再狭窄患者分别有35%和48%无症状。在晚期对照血管造影术前的运动试验中，T组和对照组分别有77%和73%的再狭窄患者异常（心绞痛和/或ST段压低）。因此，根据我们的经验，250毫克/天剂量的噻氯匹定无法降低单处病变冠状动脉血管成形术后的再狭窄率。
