Piessens J, Brzostek T, Stammen F, Vanhaecke J, Vrolix M, De Geest H
Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium.
Am J Cardiol. 1989 Nov 15;64(18):1103-7. doi: 10.1016/0002-9149(89)90860-6.
To investigate the antiischemic efficacy of intravenously administered diltiazem, 42 patients were randomly allocated to receive placebo or active treatment before 1-vessel percutaneous transluminal coronary angioplasty (PTCA). The development of myocardial ischemia was studied using subjective (pain) and objective (electrocardiography) parameters. Pretreatment with intravenous diltiazem resulted in a significantly delayed onset of ischemic pain and ST-segment elevation; these variables also returned to baseline earlier after balloon deflation. Thus, intravenous diltiazem prevents or delays the onset of myocardial ischemia during repetitive transient coronary occlusions; improvement of the myocardial blood flow distal to the coronary occlusion or impedance of calcium entry into the ischemic cell are considered as possible mechanisms. Because PTCA is increasingly used in patients with poor left ventricular function and more extensive disease, and because recent evidence suggests that better PTCA results could be obtained by the use of longer inflation times, the addition of diltiazem to the classic armamentarium could be beneficial.
为研究静脉注射地尔硫䓬的抗缺血疗效，42例患者在进行单支血管经皮腔内冠状动脉成形术（PTCA）前被随机分配接受安慰剂或积极治疗。使用主观（疼痛）和客观（心电图）参数研究心肌缺血的发生情况。静脉注射地尔硫䓬预处理导致缺血性疼痛和ST段抬高的发作显著延迟；这些变量在球囊放气后也更早恢复到基线水平。因此，静脉注射地尔硫䓬可预防或延迟重复性短暂冠状动脉闭塞期间心肌缺血的发作；冠状动脉闭塞远端心肌血流的改善或钙进入缺血细胞的受阻被认为是可能的机制。由于PTCA越来越多地用于左心室功能差和疾病范围更广的患者，并且由于最近的证据表明通过使用更长的充盈时间可以获得更好的PTCA结果，因此在经典治疗方案中添加地尔硫䓬可能有益。
