Rosencher Julien, Chaïb Aurès, Barbou Franck, Arnould Marc-Antoine, Huber Arthur, Salengro Emmanuel, Jégou Arnaud, Allouch Philippe, Zuily Stéphane, Mihoub Fadila, Varenne Olivier
AP-HP, Hôpital Cochin, Service de Cardiologie, Paris, France; Université Paris Descartes. Faculté de Médecine Paris Descartes, Paris, France.
Catheter Cardiovasc Interv. 2014 Nov 1;84(5):766-71. doi: 10.1002/ccd.25163. Epub 2014 May 6.
To compare the efficacy of three vasodilators in preventing radial artery spasm (RAS) in patients undergoing transradial percutaneous coronary interventions (PCI).
731 patients were randomized to receive diltiazem 5 mg, verapamil 2.5 mg, or isosorbide dinitrate (ISDN) 1 mg before coronary intervention. RAS occurred in 20.1% in the whole population and was significantly reduced by verapamil and ISDN compared to diltiazem (16.2, 17.2, and 26.6%, respectively; P < 0.006). There was also a trend towards less severe pain (more than 8 on a numerical scale from 0 [no pain] to 10 [maximal pain]), and less severe RAS (complete catheter blockage or severe pain), among patients treated by verapamil compared to ISDN and diltiazem (1.3% vs. 2.8% vs. 2.9%, P = 0.43 and 5.1% vs. 6.2% vs. 9.5%, respectively, P = 0.13). No difference was found between the three vasodilators in terms of crossover or safety events. Female gender, failure at first attempt to access the radial artery, emergency procedures, and the use of diltiazem were independent predictors of RAS.
Verapamil and ISDN considerably reduce the incidence of RAS compared to diltiazem during transradial PCI.
比较三种血管扩张剂在经桡动脉行经皮冠状动脉介入治疗（PCI）患者中预防桡动脉痉挛（RAS）的疗效。
731例患者在冠状动脉介入治疗前被随机分配接受5毫克地尔硫䓬、2.5毫克维拉帕米或1毫克硝酸异山梨酯（ISDN）。RAS在总体人群中的发生率为20.1%，与地尔硫䓬相比，维拉帕米和ISDN使其显著降低（分别为16.2%、17.2%和26.6%；P<0.006）。与ISDN和地尔硫䓬相比，接受维拉帕米治疗的患者中，疼痛程度较轻（在从0[无疼痛]到10[最大疼痛]的数字评分中超过8分）和RAS程度较轻（完全导管堵塞或严重疼痛）的趋势也存在（分别为1.3%对2.8%对2.9%，P = 0.43；以及5.1%对6.2%对9.5%，P = 0.13）。在交叉或安全事件方面，三种血管扩张剂之间未发现差异。女性、首次尝试桡动脉穿刺失败、急诊手术以及使用地尔硫䓬是RAS的独立预测因素。
在经桡动脉PCI期间，与地尔硫䓬相比，维拉帕米和ISDN可显著降低RAS的发生率。
