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Pretreatment with Intracoronary Diltiazem Reduces Non-Q-Wave Myocardial Infarction Following Directional Atherectomy
1Minneapolis Heart Institute, 920 East 28th Street, Minneapolis, MN, 55407, USA.
The Journal of Invasive Cardiology
|May 1, 1997
Summary
Intracoronary diltiazem significantly reduced non-Q-wave myocardial infarction and abrupt closure during directional atherectomy (DCA). This suggests diltiazem may prevent complications in patients undergoing DCA procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Directional atherectomy (DCA) is associated with a higher risk of non-Q-wave myocardial infarction (MI).
- The underlying mechanism for this increased risk, potentially microvascular spasm, remained unclear.
Purpose of the Study:
- To investigate the role of microvascular spasm in creatinine phosphokinase (CPK) elevation after DCA.
- To evaluate the efficacy of intracoronary diltiazem in reducing non-Q-wave MI and abrupt closure during DCA.
Main Methods:
- A prospective study involving 193 patients receiving intracoronary diltiazem before DCA.
- Comparison with a retrospective control group of 400 patients who underwent DCA without diltiazem.
- All procedures were performed by a single interventional cardiologist.
Main Results:
- Patients receiving diltiazem showed a significant decrease in non-Q-wave MI (2.7% vs. 6.8%, p=0.04).
- A significant reduction in abrupt closure was observed in the diltiazem group (2.5% vs. 6.2%, p=0.05).
- Clinical success and need for emergency bypass surgery were similar between groups.
Conclusions:
- Intracoronary diltiazem administration prior to DCA significantly reduces the incidence of non-Q-wave MI and abrupt closure.
- Adjunctive intracoronary diltiazem is a potential strategy to improve outcomes in patients undergoing directional atherectomy.