22014
document
[ A multicenter , randomized clinical trial of intravenous diltiazem in treatment of unstable angina ] . OBJECTIVE To investigate the clinical efficacy and safety of intravenous diltiazem compared with nitroglycerin in the patients with unstable angina pectoris . METHODS A multicenter , randomized , open-label , parallel group trial was conducted . A total of 213 eligible patients were enrolled . They were randomized either to diltiazem or nitroglycerin treatment . The diltiazem was administered from 100 microg/min at the initiation of treatment , the largest dosage was 200 - 300 microg/min ; the nitroglycerin was administered from 20 microg/min at the initiation of treatment . The largest dosage was 80 - 100 microg/min . Intravenous infusion was kept over 48 hours . The endpoints included refractory angina pectoris , acute myocardial infarction , death , emergency PTCA and CABG . RESULTS ( 1 ) Intravenous diltiazem was effective on the improvement of symptom and electrocardiogram , and its effects were similar to intravenous nitroglycerin . ( 2 ) Compared with nitroglycerin , intravenous diltiazem lowered heart rate and myocardial oxygen consumption index ( systolic pressure x heart rate ) to more extent significantly . ( 3 ) After treatment , the onsets of refractory angina pectoris were reduced more significantly in the diltiazem group than in nitroglycerin group [ 4 ( 3.8 % ) vs 13 ( 11.9 % ) , RR 0.32 ( 95 % CI 0.11 - 0.96 ) , P < 0.05 ] . ( 4 ) The patients whose heart rate were reduced significantly ( < or= 50 beats per minute ) in the diltiazem group were more than in the nitroglycerin group [ 8 ( 7.7 % ) vs 0 ( 0 % ) , P < 0.01 ] . But these patients could tolerate the lower heart rate very well in the diltiazem group . ( 5 ) The needs of beta receptor blocker or calcium antagonists were reduced more significantly in the diltiazem group compared with those in the nitroglycerin group [ 2 ( 1.9 % ) vs 13 ( 11.9 % ) , P < 0.01 ] . CONCLUSION Intravenous diltiazem therapy is effective and safe for patients with unstable angina pectoris . It may significantly lower the risk of refractory angina pectoris compared with intravenous nitroglycerin .
22015
Intervention_Pharmacological
diltiazem
22016
Intervention_Pharmacological
diltiazem
22017
Intervention_Pharmacological
nitroglycerin
22018
Intervention_Pharmacological
diltiazem
22019
Intervention_Pharmacological
nitroglycerin
22020
Intervention_Pharmacological
diltiazem
22021
Intervention_Pharmacological
nitroglycerin
22022
Intervention_Pharmacological
nitroglycerin
22023
Intervention_Pharmacological
diltiazem
22024
Intervention_Pharmacological
diltiazem
22025
Intervention_Pharmacological
diltiazem
22026
Intervention_Pharmacological
diltiazem
22027
Outcome_Physical
refractory angina pectoris
22028
Outcome_Physical
acute myocardial infarction
22029
Outcome_Mortality
death
22030
Outcome_Physical
emergency PTCA
22031
Outcome_Physical
CABG
22032
Outcome_Physical
symptom and electrocardiogram
22033
Outcome_Physical
lowered heart rate
22034
Outcome_Other
myocardial oxygen consumption index
22035
Outcome_Physical
onsets of refractory angina pectoris
22036
Outcome_Other
reduced more significantly
22037
Outcome_Physical
heart rate
22038
Outcome_Other
reduced significantly
22039
Outcome_Physical
heart rate
22040
Participant_Condition
angina
22041
Participant_Condition
unstable angina pectoris
22042
Participant_Sample-size
213