Beneficial effects of diltiazem during myocardial reperfusion: A randomized trial in acute myocardial infarction

G. Pizzetti, A. Mailhac, L. Li Volsi, F. Di Marco, C. Lu, A. Margonato, S. L. Chierchia

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Background: Although in experimental models of coronary occlusion diltiazem administration has been shown to reduce the degree of stunning and of reperfusion injury, the majority of clinical trials has failed to demonstrate significant benefits. The aim of this study was to evaluate the effect of diltiazem, administered before coronary reperfusion, on infarct size, residual myocardial viability and recovery of left ventricular function. Methods. We studied 90 patients admitted within 3 hours of the onset of symptoms of acute myocardial infarction. They were immediately randomized to either intravenous diltiazem (10 mg bolus + 10 mg/hour for 3 days) (group 1, n = 43) or placebo (group 2, n = 47) and subsequently treated with recombinant tissue-type plasminogen activator. All underwent serial echocardiograms upon admission, 4 days post-admission during low-dose dobutamine stress echo, at discharge and after 6 months. We calculated the dysfunction score (1 = hypokinesia, 2 = akinesia, 3 = dyskinesia) on admission and its percent reduction after dobutamine (viability) and at follow-up (recovery). The 12-lead electrocardiograms were continuously monitored for 3 days and coronary angioplasty was performed whenever the residual stenosis was > 60%. Results. Upon admission, there were no differences in age, sex, infarct location and size, degree of ST-segment elevation, time from onset of symptoms and dysfunction score. Creatine kinase peaked early in 70% of patients in both groups; the incidences of recurrent ischemia, infarct-related vessel patency and the need for coronary angioplasty were also similar. The creatine kinase peak was significantly higher in group 2 (2931 ± 2456 vs 1726 ± 1004 IU/I, p <0.05). Conversely, in group 1 the residual viability was significantly higher (51 ± 23 vs 36 ± 30% improvement in dysfunction score, p <0.05) and the early recovery of regional function was significantly greater (35 ± 34 vs 18 ± 22% at discharge, p <0.05). On the other hand, the delayed recovery was not significantly different (15 ± 29 vs 21 ± 32% from the time of discharge to 6 months of follow-up). Conclusions. Intravenous diltiazem, started before coronary reperfusion, has beneficial effects on the infarct size, residual viability and recovery of regional function. If confirmed by larger trials, these preliminary results suggest the use of diltiazem, as adjunctive therapy in patients with acute myocardial infarction and undergoing reperfusion.

Original languageEnglish
Pages (from-to)757-765
Number of pages9
JournalItalian Heart Journal
Volume2
Issue number10
Publication statusPublished - 2001

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Myocardial Reperfusion
Diltiazem
Myocardial Infarction
Dobutamine
Recovery of Function
Creatine Kinase
Angioplasty
Hypokinesia
Coronary Occlusion
Dyskinesias
Tissue Plasminogen Activator
Reperfusion Injury
Left Ventricular Function
Reperfusion
Electrocardiography
Pathologic Constriction
Theoretical Models
Ischemia
Placebos
Clinical Trials

Keywords

  • Acute myocardial infarction
  • Diltiazem
  • Myocardial viability
  • Reperfusion injury

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Pizzetti, G., Mailhac, A., Li Volsi, L., Di Marco, F., Lu, C., Margonato, A., & Chierchia, S. L. (2001). Beneficial effects of diltiazem during myocardial reperfusion: A randomized trial in acute myocardial infarction. Italian Heart Journal, 2(10), 757-765.

Beneficial effects of diltiazem during myocardial reperfusion : A randomized trial in acute myocardial infarction. / Pizzetti, G.; Mailhac, A.; Li Volsi, L.; Di Marco, F.; Lu, C.; Margonato, A.; Chierchia, S. L.

In: Italian Heart Journal, Vol. 2, No. 10, 2001, p. 757-765.

Research output: Contribution to journalArticle

Pizzetti, G, Mailhac, A, Li Volsi, L, Di Marco, F, Lu, C, Margonato, A & Chierchia, SL 2001, 'Beneficial effects of diltiazem during myocardial reperfusion: A randomized trial in acute myocardial infarction', Italian Heart Journal, vol. 2, no. 10, pp. 757-765.
Pizzetti, G. ; Mailhac, A. ; Li Volsi, L. ; Di Marco, F. ; Lu, C. ; Margonato, A. ; Chierchia, S. L. / Beneficial effects of diltiazem during myocardial reperfusion : A randomized trial in acute myocardial infarction. In: Italian Heart Journal. 2001 ; Vol. 2, No. 10. pp. 757-765.
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abstract = "Background: Although in experimental models of coronary occlusion diltiazem administration has been shown to reduce the degree of stunning and of reperfusion injury, the majority of clinical trials has failed to demonstrate significant benefits. The aim of this study was to evaluate the effect of diltiazem, administered before coronary reperfusion, on infarct size, residual myocardial viability and recovery of left ventricular function. Methods. We studied 90 patients admitted within 3 hours of the onset of symptoms of acute myocardial infarction. They were immediately randomized to either intravenous diltiazem (10 mg bolus + 10 mg/hour for 3 days) (group 1, n = 43) or placebo (group 2, n = 47) and subsequently treated with recombinant tissue-type plasminogen activator. All underwent serial echocardiograms upon admission, 4 days post-admission during low-dose dobutamine stress echo, at discharge and after 6 months. We calculated the dysfunction score (1 = hypokinesia, 2 = akinesia, 3 = dyskinesia) on admission and its percent reduction after dobutamine (viability) and at follow-up (recovery). The 12-lead electrocardiograms were continuously monitored for 3 days and coronary angioplasty was performed whenever the residual stenosis was > 60{\%}. Results. Upon admission, there were no differences in age, sex, infarct location and size, degree of ST-segment elevation, time from onset of symptoms and dysfunction score. Creatine kinase peaked early in 70{\%} of patients in both groups; the incidences of recurrent ischemia, infarct-related vessel patency and the need for coronary angioplasty were also similar. The creatine kinase peak was significantly higher in group 2 (2931 ± 2456 vs 1726 ± 1004 IU/I, p <0.05). Conversely, in group 1 the residual viability was significantly higher (51 ± 23 vs 36 ± 30{\%} improvement in dysfunction score, p <0.05) and the early recovery of regional function was significantly greater (35 ± 34 vs 18 ± 22{\%} at discharge, p <0.05). On the other hand, the delayed recovery was not significantly different (15 ± 29 vs 21 ± 32{\%} from the time of discharge to 6 months of follow-up). Conclusions. Intravenous diltiazem, started before coronary reperfusion, has beneficial effects on the infarct size, residual viability and recovery of regional function. If confirmed by larger trials, these preliminary results suggest the use of diltiazem, as adjunctive therapy in patients with acute myocardial infarction and undergoing reperfusion.",
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T1 - Beneficial effects of diltiazem during myocardial reperfusion

T2 - A randomized trial in acute myocardial infarction

AU - Pizzetti, G.

AU - Mailhac, A.

AU - Li Volsi, L.

AU - Di Marco, F.

AU - Lu, C.

AU - Margonato, A.

AU - Chierchia, S. L.

PY - 2001

Y1 - 2001

N2 - Background: Although in experimental models of coronary occlusion diltiazem administration has been shown to reduce the degree of stunning and of reperfusion injury, the majority of clinical trials has failed to demonstrate significant benefits. The aim of this study was to evaluate the effect of diltiazem, administered before coronary reperfusion, on infarct size, residual myocardial viability and recovery of left ventricular function. Methods. We studied 90 patients admitted within 3 hours of the onset of symptoms of acute myocardial infarction. They were immediately randomized to either intravenous diltiazem (10 mg bolus + 10 mg/hour for 3 days) (group 1, n = 43) or placebo (group 2, n = 47) and subsequently treated with recombinant tissue-type plasminogen activator. All underwent serial echocardiograms upon admission, 4 days post-admission during low-dose dobutamine stress echo, at discharge and after 6 months. We calculated the dysfunction score (1 = hypokinesia, 2 = akinesia, 3 = dyskinesia) on admission and its percent reduction after dobutamine (viability) and at follow-up (recovery). The 12-lead electrocardiograms were continuously monitored for 3 days and coronary angioplasty was performed whenever the residual stenosis was > 60%. Results. Upon admission, there were no differences in age, sex, infarct location and size, degree of ST-segment elevation, time from onset of symptoms and dysfunction score. Creatine kinase peaked early in 70% of patients in both groups; the incidences of recurrent ischemia, infarct-related vessel patency and the need for coronary angioplasty were also similar. The creatine kinase peak was significantly higher in group 2 (2931 ± 2456 vs 1726 ± 1004 IU/I, p <0.05). Conversely, in group 1 the residual viability was significantly higher (51 ± 23 vs 36 ± 30% improvement in dysfunction score, p <0.05) and the early recovery of regional function was significantly greater (35 ± 34 vs 18 ± 22% at discharge, p <0.05). On the other hand, the delayed recovery was not significantly different (15 ± 29 vs 21 ± 32% from the time of discharge to 6 months of follow-up). Conclusions. Intravenous diltiazem, started before coronary reperfusion, has beneficial effects on the infarct size, residual viability and recovery of regional function. If confirmed by larger trials, these preliminary results suggest the use of diltiazem, as adjunctive therapy in patients with acute myocardial infarction and undergoing reperfusion.

AB - Background: Although in experimental models of coronary occlusion diltiazem administration has been shown to reduce the degree of stunning and of reperfusion injury, the majority of clinical trials has failed to demonstrate significant benefits. The aim of this study was to evaluate the effect of diltiazem, administered before coronary reperfusion, on infarct size, residual myocardial viability and recovery of left ventricular function. Methods. We studied 90 patients admitted within 3 hours of the onset of symptoms of acute myocardial infarction. They were immediately randomized to either intravenous diltiazem (10 mg bolus + 10 mg/hour for 3 days) (group 1, n = 43) or placebo (group 2, n = 47) and subsequently treated with recombinant tissue-type plasminogen activator. All underwent serial echocardiograms upon admission, 4 days post-admission during low-dose dobutamine stress echo, at discharge and after 6 months. We calculated the dysfunction score (1 = hypokinesia, 2 = akinesia, 3 = dyskinesia) on admission and its percent reduction after dobutamine (viability) and at follow-up (recovery). The 12-lead electrocardiograms were continuously monitored for 3 days and coronary angioplasty was performed whenever the residual stenosis was > 60%. Results. Upon admission, there were no differences in age, sex, infarct location and size, degree of ST-segment elevation, time from onset of symptoms and dysfunction score. Creatine kinase peaked early in 70% of patients in both groups; the incidences of recurrent ischemia, infarct-related vessel patency and the need for coronary angioplasty were also similar. The creatine kinase peak was significantly higher in group 2 (2931 ± 2456 vs 1726 ± 1004 IU/I, p <0.05). Conversely, in group 1 the residual viability was significantly higher (51 ± 23 vs 36 ± 30% improvement in dysfunction score, p <0.05) and the early recovery of regional function was significantly greater (35 ± 34 vs 18 ± 22% at discharge, p <0.05). On the other hand, the delayed recovery was not significantly different (15 ± 29 vs 21 ± 32% from the time of discharge to 6 months of follow-up). Conclusions. Intravenous diltiazem, started before coronary reperfusion, has beneficial effects on the infarct size, residual viability and recovery of regional function. If confirmed by larger trials, these preliminary results suggest the use of diltiazem, as adjunctive therapy in patients with acute myocardial infarction and undergoing reperfusion.

KW - Acute myocardial infarction

KW - Diltiazem

KW - Myocardial viability

KW - Reperfusion injury

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