Intravenous diltiazem versus nitroglycerin for silent and symptomatic myocardial ischemia in unstable angina pectoris

Fang, Zhen; Picart, N; Abramowicz, Marc; Unger, Philippe; Narracci, Pascale; Sobolski, John; Berkenboom, Guy; Scheldewaert, Rudy; Degré, Serge

doi:10.1016/0002-9149(91)90222-7

Cited by 11 publications

(2 citation statements)

References 19 publications

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“…The present study shows that for early therapy without concomitant treatment with nitrates or beta-blockers, and in contrast with dihydropyridines, cIV Dil at a dosage of 1-5 µg/kg/min is effective in remission of angina and prevention of initial recurrence of ischemic events, and can be safely used in most patients with UAP regardless of all types, of their underlying coronary arterial lesions and ECG manifestations. 5,6 Keeping the patients with UAP stable for 48 h allowed the physicians to take their time with noninvasive risk stratification. A low-risk selective coronary arterial intervention could then be performed later on if necessary.…”

Section: Discussionmentioning

confidence: 99%

“…3 Diltiazem (Dil), a nondihydropyridine calcium antagonist, is also considered to be a useful anti-ischemic drug in the medical therapy of angina pectoris; however, the use of intravenous Dil as a first-line medication for primitive management of UAP has been assessed to a lesser extent. [4][5][6] This prospective, multicenter trial evaluated the efficacy, optimal dosage, and safety of continuous intravenous infusion (cIV) Dil for initial treatment in UAP remission.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of the efficacy, optimal dosage, and safety of diltiazem in early treatment of unstable angina pectoris

Bai

2005

Clinical Cardiology

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SummaryBackground: The anti-ischemic benefits of diltiazem are well recognized; however, there are fewer studies of the use of intravenous diltiazem for early treatment of unstable angina pectoris (UAP).Hypothesis: The present study prospectively evaluated the efficacy, optimal dosage, and safety of continuous intravenous diltiazem for initial management of UAP.Methods: In all, 102 patients with UAP were recruited in this multicenter trial. Diltiazem was administered as a continuous intravenous infusion with a fixed incremental dosage of 1, 3, and 5 µg/kg/min, titrated according to the patients' symptoms of angina, and then was maintained for a further 48 h at the angina-free dose. Episodes of angina, hemodynamic stability, and complications were observed.Results: Angina was adequately controlled with continuous intravenous infusion of diltiazem in 64 patients (63%) at a dosage of 1 µg/kg/min, in 26 patients (25%) at dosage of 3 µg/kg/ min, and in 6 patients (6%) at dosage of 5 µg/kg/min, leading to a cumulative effective ratio of 94% in all patients. Additional anti-ischemic medications were required in six patients (6%) who had refractory angina. Bradyarrhythmias noted in only six patients (6%) were reversible after decreasing the

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Assessment of the efficacy, optimal dosage, and safety of diltiazem in early treatment of unstable angina pectoris

Bai

2005

Clinical Cardiology

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The periangioplasty polypharmacy: A role for diltiazem?

Turi

1995

Cathet. Cardiovasc. Diagn.

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The paper by Dr. Mclvor and colleagues broadly entitled "Clinical Effects and Utility of Intracoronary Diltiazem" raises significant issues about adjunctive therapy during angioplasty. There is limited published data on parenteral diltiazem use during PTCA; this study describes a small number of patients receiving a fixed dose via intracoronary administration.Intracoronary diltiazem has at least five potential applications during coronary angioplasty. First, it could provide epicardial vasodilation prior to instrumentation: a 10 to 20% increase in luminal diameter in both normal [ I ] and diseased [2] segments has been demonstrated by others and confirmed in this paper, albeit in diseased segments only. Second, it could attenuate ischemia during balloon inflation, allowing for better-tolerated and longer inflations, and potentially limit myocardial necrosis [3]. Careful studies of a number of agents, including nitroglycerin [4], propranolol [ 5 ] , verapamil (61, nifedipine [7], as well as intravenous diltiazem [8,9] have demonstrated reduction of ischemia during balloon occlusion. Third, intracoronary diltiazem could provide treatment for severe coronary vasospasm or no-ref low phenomenon, the latter seen after embolization of clot, debris from degenerated vein grafts, or during routine rotational atherectomy. Fourth, diltiazem could have adjunctive benefit, based on data from intravenous studies, on heart rate control during angioplasty by preventing supraventricular tachycardia and preventing catecholamine mediated sinus tachycardia [lo]. Finally, it may have potential hemodynamic benefits through its vasodilator activity and early improvement in segmental systolic function [ 1 I ] in selected patients.McIvor and colleagues report the effects of intracoronary diltiazem on heart rate, blood pressure, electrical conduction, and coronary artery diameters. In an earlier study, we looked at myocardial ischemia as measured by ST segment changes and chest pain score \ 121, using a much higher dose of intracoronary diltiazem (100 pg/kg) in a randomized comparison with placebo. We found marked reduction of ST segment elevation and chest pain. This was achieved at the penalty of a >40% incidence of significant but transient conduction distrubances, although the dosage was substantially higher than that described in this issue of the Journal. We speculated initially that avoiding infusion into a right coronary artery supplying both the sinus and a-v nodal arteries might eliminate conduction problems, but experienced similar bradyarrhythmias with injection into the LAD and nondominant left circumflex arteries as well.Thus we would like to sound a note of caution regarding the encouraging findings reported by Dr. McIvor and colleagues that intracoronary diltiazem given slowly at low dose appeared to be safe in their 12 patients. The use of intracoronary diltiazem is likely to be considered for severe vasospasm and for no-reflow type ischemia, currently most common with use of the Rotablator. In most laboratories, this pa...

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Time significance of acute thrombotic reactant markers in patients with and without silent myocardial ischemia and overt unstable angina pectoris

Gurfinkel

Bozovich

Cerdá

et al. 1995

The American Journal of Cardiology

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Intravenous diltiazem versus nitroglycerin for silent and symptomatic myocardial ischemia in unstable angina pectoris

Cited by 11 publications

References 19 publications

Assessment of the efficacy, optimal dosage, and safety of diltiazem in early treatment of unstable angina pectoris

Assessment of the efficacy, optimal dosage, and safety of diltiazem in early treatment of unstable angina pectoris

The periangioplasty polypharmacy: A role for diltiazem?

Time significance of acute thrombotic reactant markers in patients with and without silent myocardial ischemia and overt unstable angina pectoris

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