冠状动脉内硝酸甘油和地尔硫卓对冠状动脉慢血流现象的急性影响。

Acute effects of intracoronary nitroglycerin and diltiazem in coronary slow flow phenomenon.

机构信息

Department of Cardiology, Erciyes University Medical Faculty, Kayseri, Turkey.

出版信息

J Investig Med. 2013 Jan;61(1):45-9. doi: 10.2310/JIM.0b013e318279b7f6.

DOI:10.2310/JIM.0b013e318279b7f6

PMID:23222003

Abstract

BACKGROUND

The coronary slow flow phenomenon (CSFP) is a coronary microvascular disorder angiographically defined by delayed opacification of the distal vasculature in the absence of obstructive coronary artery disease. We aimed to investigate and compare the effects of intracoronary nitrate and diltiazem on thrombolysis in myocardial infarction frame count (TFC) in patients with CSFP during coronary angiography.

METHODS

Sixty patients with CSFP were randomly divided into 2 groups. The first group is nitroglycerin group with 30 patients (22 men; mean [SD] age, 50 [12] years), and the second is diltiazem group with 30 patients (27 men; mean age, 54 ± 11 years); intracoronary 5-mg diltiazem or 250-μg nitroglycerin was administered. Heart rate, systolic and diastolic blood pressures, and TFCs in all 3 coronaries were recorded before and after administering these medications.

RESULTS

After nitroglycerin administration, systolic and diastolic blood pressures decreased, heart rates significantly increased, and TFCs decreased in all coronaries (P < 0.001 for 3 coronaries). After the application of intracoronary 5-mg diltiazem, heart rate, systolic and diastolic blood pressures, and TFCs were found significantly lower than predrug values (P < 0.001 for all values). When the percent TFC reductions, after the application of intracoronary diltiazem or nitroglycerin, in left anterior descending coronary artery, circumflex coronary artery, and right coronary artery were evaluated, diltiazem significantly reduced the TFCs of the left anterior descending coronary artery and circumflex coronary artery compared with nitroglycerin (P < 0.01 for both coronaries).

CONCLUSION

Both intracoronary diltiazem and nitroglycerin improve the TFCs in CSFP, and intracoronary diltiazem is superior to nitroglycerin in reducing TFCs in CSFP.

摘要

背景

冠状动脉慢血流现象（CSFP）是一种冠状动脉微血管疾病，其特征为在不存在阻塞性冠状动脉疾病的情况下，远端血管的显影延迟。本研究旨在探讨和比较冠状动脉造影时冠状动脉内给予硝酸酯类和地尔硫卓对 CSFP 患者心肌梗死溶栓治疗帧数（TFC）的影响。

方法

60 例 CSFP 患者随机分为 2 组。第 1 组为硝酸甘油组，共 30 例（男 22 例；平均年龄 50 [12]岁），第 2 组为地尔硫卓组，共 30 例（男 27 例；平均年龄 54 ± 11 岁）；分别给予冠状动脉内 5mg 地尔硫卓或 250μg 硝酸甘油。记录所有患者 3 支冠状动脉给药前后的心率、收缩压和舒张压以及 TFC。

结果

给予硝酸甘油后，3 支冠状动脉的收缩压和舒张压均降低，心率明显增加，TFC 均降低（3 支冠状动脉均 P<0.001）。给予冠状动脉内 5mg 地尔硫卓后，心率、收缩压、舒张压和 TFC 均明显低于用药前（所有值均 P<0.001）。评价冠状动脉内给予地尔硫卓或硝酸甘油后，左前降支、回旋支和右冠状动脉的 TFC 减少百分比，发现地尔硫卓与硝酸甘油相比，明显降低了左前降支和回旋支的 TFC（两支冠状动脉均 P<0.01）。