Wilson J, Silverton N P, Baig M W, Perrins E J, Smith D R, Davies J A, Prentice C R
University Department of Medicine, General Infirmary, Leeds.
Br Heart J. 1988 Nov;60(5):373-6. doi: 10.1136/hrt.60.5.373.
Because epoprostenol (prostacyclin) is a prostaglandin that causes vasodilatation and inhibits platelet function it may be of benefit during coronary artery angioplasty. The safety and capacity of intracoronary epoprostenol to dilate coronary arteries were assessed in 16 patients undergoing routine coronary angiography. The view that best displayed the left epicardial coronary arteries was selected as a control for each patient. Intracoronary epoprostenol was then given and the angiogram was repeated in the chosen view. The procedure was repeated twice: once with a higher dose of epoprostenol and once after intracoronary isosorbide dinitrate. Angiograms were coded and analysed by an observer who was unaware of the treatment. The calibre of the arteries was measured from traced projections of the angiograms. The blood pressure, heart rate, and electrocardiogram were recorded throughout. The first two patients were given epoprostenol infusions of 2.5 and 5.0 ng/kg per minute to assess safety, and there were no untoward reactions. The next ten patients had epoprostenol infusions of 5.0 and 7.5 ng/kg per minute followed by intracoronary isosorbide dinitrate. No haemodynamic disturbances occurred and coronary luminal calibre did not change with epoprostenol (mean (SD) luminal diameter: 2.85 (0.62) mm control, 2.80 (0.61) mm at 5.0 ng/kg, and 2.80 (0.54) mm at 7.5 ng/kg), but it did increase significantly with isosorbide dinitrate (to 3.17 (0.36) mm). The last four patients had epoprostenol infusions of 7.5 and 10 ng/kg followed by intracoronary isosorbide dinitrate and two of them became hypotensive (one after epoprostenol and one after isosorbide dinitrate). Coronary luminal calibre did not change significantly (3.5 (0.45) mm control, 2.96 (0.81) mm at 7.5 ng/kg, 3.45 (0.96) mm at 10 ng/kg, and 3.20 (0.61) mm with isosorbide dinitrate). Eight patients developed tall T waves on the electrocardiogram during epoprostenol infusion but none had arrhythmias. The results indicate that clinically tolerable doses of intracoronary epoprostenol do not significantly dilate the epicardial coronary arteries. This route of administration is therefore unlikely to be of use during coronary angioplasty, although the antiplatelet action of intravenous epoprostenol might help to prevent restenosis.
由于依前列醇（前列环素）是一种能引起血管舒张并抑制血小板功能的前列腺素，它在冠状动脉血管成形术期间可能有益。对16例接受常规冠状动脉造影的患者评估了冠状动脉内依前列醇扩张冠状动脉的安全性和能力。为每位患者选择显示左心外膜冠状动脉的最佳视图作为对照。然后给予冠状动脉内依前列醇，并在所选视图中重复血管造影。该过程重复两次：一次使用较高剂量的依前列醇，一次在冠状动脉内给予硝酸异山梨酯之后。血管造影由一位不知道治疗情况的观察者进行编码和分析。从血管造影的追踪投影测量动脉的管径。全程记录血压、心率和心电图。前两名患者分别以每分钟2.5和5.0 ng/kg的剂量输注依前列醇以评估安全性，未出现不良反应。接下来的10名患者以每分钟5.0和7.5 ng/kg的剂量输注依前列醇，随后给予冠状动脉内硝酸异山梨酯。未发生血流动力学紊乱，冠状动脉管腔直径在使用依前列醇时未改变（平均（标准差）管腔直径：对照时为2.85（0.62）mm，5.0 ng/kg时为2.80（0.61）mm，7.5 ng/kg时为2.80（0.54）mm），但在使用硝酸异山梨酯后显著增加（至3.17（0.36）mm）。最后4名患者以每分钟7.5和10 ng/kg的剂量输注依前列醇，随后给予冠状动脉内硝酸异山梨酯，其中2人出现低血压（1人在使用依前列醇后，1人在使用硝酸异山梨酯后）。冠状动脉管腔直径无显著变化（对照时为3.5（0.45）mm，7.5 ng/kg时为2.96（0.81）mm，10 ng/kg时为3.45（0.96）mm，使用硝酸异山梨酯时为3.20（0.61）mm）。8名患者在输注依前列醇期间心电图出现高T波，但均未发生心律失常。结果表明，临床上可耐受剂量的冠状动脉内依前列醇不会显著扩张心外膜冠状动脉。因此，尽管静脉输注依前列醇的抗血小板作用可能有助于预防再狭窄，但这种给药途径在冠状动脉血管成形术期间不太可能有用。
