Hashino T, Ikeda H, Ueno T, Imaizumi T
Third Department of Internal Medicine, Kurume University School of Medicine, Japan.
J Am Coll Cardiol. 1996 Dec;28(7):1725-31. doi: 10.1016/S0735-1097(96)00396-8.
We investigated the effect of aminophylline, an antagonist of the adenosine P1 receptor, on cardiac pain experienced during percutaneous transluminal coronary angioplasty (PTCA).
Adenosine may mediate cardiac pain because the administration of adenosine provokes cardiac pain like angina. However, it is not known whether endogenous adenosine released during myocardial ischemia is responsible for cardiac pain.
This was a single-blind, placebo-controlled randomized study. Of 21 men with stable effort angina with one-vessel coronary artery disease who underwent balloon inflation four times during PTCA, 11 received intravenously administered aminophylline before the fourth balloon inflation and the other 10 were given saline solution. The severity of cardiac pain based on the pain score and ST segment elevation on standard surface and intracoronary electrocardiograms were assessed.
All patients experienced cardiac pain during balloon inflation. Aminophylline significantly prolonged the duration of both the symptom-free interval (from 42 +/- 13 to 64 +/- 27 s, mean +/- SD, p < 0.05) and inflation time (from 79 +/- 23 to 103 +/- 20 s, p < 0.05), and it significantly reduced the pain score from 7.6 +/- 1.4 to 4.6 +/- 2.3 (p < 0.01). However, aminophylline did not affect ST segment elevation. Saline solution did not affect any of these variables. Balloon diameter and pressure were not different between the third and the fourth inflation in either group.
Aminophylline significantly reduced the severity of cardiac pain during PTCA without affecting ST segment elevation. These findings suggest that the activation of P1 receptors by endogenous adenosine may be partially responsible for cardiac pain during ischemia.
我们研究了腺苷P1受体拮抗剂氨茶碱对经皮腔内冠状动脉成形术（PTCA）期间所经历的心源性疼痛的影响。
腺苷可能介导心源性疼痛，因为给予腺苷会引发类似心绞痛的心源性疼痛。然而，尚不清楚心肌缺血期间释放的内源性腺苷是否是心源性疼痛的原因。
这是一项单盲、安慰剂对照的随机研究。21名患有单支冠状动脉疾病的稳定劳力型心绞痛男性患者在PTCA期间接受了4次球囊扩张，其中11名患者在第4次球囊扩张前静脉注射氨茶碱，另外10名患者给予生理盐水。根据疼痛评分以及标准体表和冠状动脉内心电图上的ST段抬高情况评估心源性疼痛的严重程度。
所有患者在球囊扩张期间均经历了心源性疼痛。氨茶碱显著延长了无症状间期（从42±13秒延长至64±27秒，平均值±标准差，p<0.05）和扩张时间（从79±23秒延长至103±20秒，p<0.05），并且将疼痛评分从7.6±1.4显著降低至4.6±2.3（p<0.01）。然而，氨茶碱并未影响ST段抬高。生理盐水对这些变量均无影响。两组中第三次和第四次扩张时的球囊直径和压力并无差异。
氨茶碱在不影响ST段抬高的情况下显著降低了PTCA期间的心源性疼痛严重程度。这些发现表明内源性腺苷激活P1受体可能部分导致缺血期间的心源性疼痛。
