Usefulness of calcium entry blockers during and after percutaneous transluminal coronary artery angioplasty.

Calcium entry blockers can decrease myocardial ischemia and coronary spasm in association with percutaneous transluminal coronary artery angioplasty (PTCA). Restenosis after PTCA has not been shown to be statistically decreased by nifedipine or diltiazem in patients who clinically did not have coronary spasm. Patients who have evidence of coronary spasm before or at PTCA have a higher incidence of restenosis after PTCA, but this is decreased by treatment with calcium entry blockers. Most patients at Emory receive a calcium entry blocker before and after PTCA while in the hospital. After discharge, long-term therapy is given to select patients, especially those with any evidence of coronary vasospasm or patients with incompletely revascularized, multivessel disease. All patients receive aspirin before and long-term after PTCA. Some physicians give calcium entry blockers to all patients after PTCA. There is a need for larger, controlled clinical trials to evaluate the current use of calcium entry blockers before, during, and after PTCA as well as other therapeutic agents to prevent acute and chronic restenosis.