Ramamurthy S, Mehan V, Kaufmann U, Verin V, Lüscher T F, Meier B
Department of Medicine, University Hospital, Bern, Switzerland.
Heart. 1996 Dec;76(6):471-6. doi: 10.1136/hrt.76.6.471.
In the light of the reported inconsistent anti-ischaemic and antianginal effects of transdermal glyceryl trinitrate, its efficacy and influence on the effects of intracoronary glyceryl trinitrate were examined during coronary angioplasty, which provides a model of controlled, reversible ischaemia.
Double blind, randomised study of the effect of transdermal and intracoronary glyceryl trinitrate on ischaemia during coronary angioplasty.
40 patients with isolated severe stenosis of the left anterior descending coronary artery.
Patients were randomised (double blind) to transdermal glyceryl trinitrate (10 mg per day) and placebo, starting four to six hours before angioplasty. After 4 one-minute balloon inflations intracoronary glyceryl trinitrate was injected (0.2 mg) and then 4 further one-minute inflations were performed.
The time to angina and the time to > 0.2 mV ST shift on surface electrocardiogram (ECG) or intracoronary ECG during the individual inflations.
These times did not significantly differ during initial inflations between transdermal glyceryl trinitrate (27 (11), 25 (9), and 19 (9) s, respectively) and placebo (34 (11), 30 (8), and 21 (7) s. After intracoronary glyceryl trinitrate, they were significantly prolonged compared with the initial values, without differences between patients with transdermal glyceryl trinitrate (37 (10), 30 (8), and 23 (8) s, respectively) or placebo (39 (15), 36 (11), and 28 (12) s). Ischaemic preconditioning was not seen.
Transdermal glyceryl trinitrate (10 mg per day), unlike intracoronary glyceryl trinitrate, did not alleviate the myocardial ischaemia produced by balloon inflation during coronary angioplasty.
鉴于有报道称经皮硝酸甘油的抗缺血和抗心绞痛作用不一致，在冠状动脉成形术（这是一种可控的、可逆性缺血模型）过程中，研究了其疗效以及对冠状动脉内硝酸甘油作用的影响。
关于经皮和冠状动脉内硝酸甘油对冠状动脉成形术期间缺血影响的双盲、随机研究。
40例左前降支冠状动脉孤立性严重狭窄患者。
患者在血管成形术前4至6小时开始被随机（双盲）分为接受经皮硝酸甘油（每日10毫克）和安慰剂治疗。在4次1分钟的球囊充盈后，注入冠状动脉内硝酸甘油（0.2毫克），然后再进行4次1分钟的充盈。
每次充盈期间出现心绞痛的时间以及体表心电图（ECG）或冠状动脉内ECG上ST段偏移>0.2 mV的时间。
在最初的充盈期间，经皮硝酸甘油组（分别为27（11）、25（9）和19（9）秒）和安慰剂组（34（11）、30（8）和21（7）秒）之间这些时间无显著差异。冠状动脉内注入硝酸甘油后，与初始值相比，这些时间显著延长，经皮硝酸甘油组患者（分别为37（10）、30（8）和23（8）秒）和安慰剂组患者（39（15）、36（11）和28（12）秒）之间无差异。未观察到缺血预处理现象。
与冠状动脉内硝酸甘油不同，经皮硝酸甘油（每日10毫克）在冠状动脉成形术期间不能减轻球囊充盈所产生的心肌缺血。
