Distante A, Sabino F, L'Abbate A
C.N.R., Institute of Clinical Physiology, University of Pisa, Italy.
Eur Heart J. 1988 Jan;9 Suppl A:155-64. doi: 10.1093/eurheartj/9.suppl_a.155.
The aim of this study was to explore the capability of isosorbide dinitrate (ISDN) infusion to quench the 'hot phase' of unstable angina, a real cardiological emergency. Fifteen patients consecutively admitted to CCU because of angina at rest, with at least 4 ischaemic attacks per day, resistant to the usual therapy with oral and/or topical nitrates and calcium-antagonists, were included in the study. During ischaemia the electrocardiogram showed ST-segment elevation in 7 patients, ST-segment depression in 4, an alternation of ST-segment elevation and depression in 3 and pseudonormalization of a basally negative T wave in 1 patient. History of exertional angina with variable degrees of effort was reported in 6 patients and 9 had an old myocardial infarction. Coronary arteriography performed in 10 patients showed a significant stenosis of 1, 2 and 3 vessels in 5, 2 and 3 patients, respectively. ISDN infusion was started at 1.0 mg h-1, and was increased stepwise when persistence of ischaemic episodes had to be faced. The mean dosage infused was 3.5 mg h-1 (range 1.00-12). The mean duration of intravenous therapy was 8.3 days (range 2-25). Eleven of the 15 patients (73%) showed an effective decrease in the number of ischaemic episodes during ISDN infusion, as assessed by regression and variance analysis. After discharge (mean follow-up 59 months, range 2-96), 7 patients were free from ischaemic attacks, 3 underwent coronary by-pass surgery, 2 complained of some attacks and 3 died (2 because of sudden death three years after this study). In conclusion, ISDN infusion--individually tailored for dosage and duration--can be effective in 'cooling down' the storm of ischaemic episodes in unstable angina. An effective intravenous therapy with nitrates can represent, in some patients, a temporal remedy on the way to elective coronary bypass surgery and/or towards elective PTCA. Furthermore, in a sizeable number of patients with unstable angina, this approach can attain a complete abolishment of the ischaemic attacks.
本研究的目的是探讨静脉输注硝酸异山梨酯（ISDN）缓解不稳定型心绞痛“急性期”的能力，不稳定型心绞痛是一种真正的心脏急症。15例因静息性心绞痛连续入住冠心病监护病房（CCU）的患者被纳入研究，这些患者每天至少有4次缺血发作，对口服和/或局部应用硝酸盐及钙拮抗剂的常规治疗无效。缺血发作期间，7例患者心电图显示ST段抬高，4例显示ST段压低，3例显示ST段抬高与压低交替出现，1例患者基础倒置T波假性正常化。6例患者有劳力性心绞痛病史，发作程度不一，9例有陈旧性心肌梗死。10例行冠状动脉造影的患者中，分别有5例、2例和3例显示1支、2支和3支血管存在明显狭窄。ISDN输注起始剂量为1.0 mg/h，当仍有缺血发作时逐步增加剂量。平均输注剂量为3.5 mg/h（范围1.00 - 12）。静脉治疗的平均持续时间为8.3天（范围2 - 25）。通过回归分析和方差分析评估，15例患者中有11例（73%）在ISDN输注期间缺血发作次数有效减少。出院后（平均随访59个月，范围2 - 96个月），7例患者无缺血发作，3例行冠状动脉搭桥手术，2例仍有发作，3例死亡（2例在本研究3年后猝死）。总之，根据剂量和持续时间进行个体化调整的ISDN输注可有效“平息”不稳定型心绞痛的缺血发作风暴。有效的硝酸盐静脉治疗在某些患者中可作为择期冠状动脉搭桥手术和/或择期经皮冠状动脉腔内血管成形术（PTCA）前的临时治疗方法。此外，在相当一部分不稳定型心绞痛患者中，这种方法可实现缺血发作的完全消除。
