Comparison of propranolol, diltiazem, and nifedipine in the treatment of ambulatory ischemia in patients with stable angina. Differential effects on ambulatory ischemia, exercise performance, and anginal symptoms. The ASIS Study Group.
Comparison of propranolol, diltiazem, and nifedipine in the treatment of ambulatory ischemia in patients with stable angina. Differential effects on ambulatory ischemia, exercise performance, and anginal symptoms. The ASIS Study Group.
复制标题
普萘洛尔、地尔硫卓和硝苯地平治疗稳定性心绞痛患者动态缺血的比较。
DOI：
10.1161/01.cir.82.6.1962
复制
发表时间：
1990
期刊：
影响因子：
37.8
通讯作者：
Raby,K
中科院分区：
文献类型：
--
作者：
Stone,PH;Gibson,RS;Glasser,SP;DeWood,MA;Parker,JD;Kawanishi,DT;Crawford,MH;Messineo,FC;Shook,TL;Raby,K
在稳定性冠状动脉疾病且通常无症状的患者中，门诊活动期间短暂性心肌缺血的发作很常见。由于缺乏直接的比较研究，无症状缺血发作的治疗选择受到限制。为了确定稳定型心绞痛和无症状缺血发作频率高的患者最有效的单一疗法，在一项随机、双盲、交叉试验中，将普萘洛尔-LA（平均每日剂量，293 mg）、地尔硫卓-SR（平均每日剂量，350 mg）、硝苯地平（平均每日剂量，79 mg）与安慰剂进行比较，各持续两周。入选标准是安慰剂治疗期间运动平板测试呈阳性，其特征是 ST 段压低 1.0 毫米或以上和心绞痛，以及 48 小时动态心电图上出现 6 次或以上短暂性 ST 段压低 1.0 毫米或以上。对 194 名患者进行了筛查，其中 63 名患者符合条件并接受了随机治疗，其中 56 名患者至少完成了四个治疗期中的两个，并被纳入意向治疗分析。五十名患者完成了所有四个治疗阶段，并被纳入方案完成分析中。通过 48 小时动态心电图监测、跑步机运动测试和心绞痛日记评估抗缺血功效。百分之九十四的动态缺血发作是无症状的。与安慰剂相比，在动态心电图监测期间，只有普萘洛尔与无症状缺血的所有表现显着减少相关（2.3 次与 1.0 次/24 小时；每 24 小时缺血平均持续时间，43.6 分钟与 5.7 分钟；两者 p 均小于 0.0001）。与安慰剂相比，地尔硫卓的发作频率降低（2.3 次对比 1.9 次/24 小时）与方案完成分析中的趋势 (p = 0.08) 以及意向治疗分析中的显着减少 (p = 0.03) 相关。硝苯地平对动态缺血的任何测量变量没有显着影响。对于某些患者来说，所使用的药物剂量可能过多，而较低剂量可能会产生更明显的有益效果。与活性药物对动态无症状缺血的显着效果相反，对运动表现和心绞痛的影响轻微。活性药物适度改善了跑步机运动持续时间，直至 ST 段压低 1 毫米（3%），只有普萘洛尔和地尔硫卓具有显着效果。只有地尔硫卓显着延长了总运动时间。普萘洛尔和地尔硫卓均显着降低心绞痛频率。（摘要截断为 400 字）
Episodes of transient myocardial ischemia during ambulatory activities are common in patients with stable coronary artery disease and who are often asymptomatic. Selection of therapy for episodes of asymptomatic ischemia is limited by a lack of direct comparative studies. To determine the most effective monotherapy for patients with stable angina and a high frequency of asymptomatic ischemic episodes, propranolol-LA (mean daily dose, 293 mg), diltiazem-SR (mean daily dose, 350 mg), nifedipine (mean daily dose, 79 mg) were each compared with placebo, each for 2 weeks, in a randomized, double-blinded, crossover trial. Entry criteria were a positive exercise treadmill test during placebo therapy characterized by 1.0 mm or more ST segment depression and angina pectoris, and six or more episodes of transient ST segment depression of 1.0 mm or more on a 48-hour ambulatory electrocardiogram. One hundred ninety-four patients were screened, 63 were eligible and received randomized therapy, of which 56 patients completed at least two of the four treatment periods and were included in an intent-to-treat analysis. Fifty patients completed all four treatment phases and were included in the protocol-completed analysis. Anti-ischemia efficacy was assessed by 48-hour ambulatory electrocardiographic monitoring, exercise treadmill tests, and anginal diaries. Ninety-four percent of all episodes of ambulatory ischemia were asymptomatic. Compared with placebo, only propranolol was associated with a marked reduction in all manifestations of asymptomatic ischemia during ambulatory electrocardiographic monitoring (2.3 versus 1.0 episodes/24 hr; mean duration of ischemia per 24 hours, 43.6 versus 5.7 minutes; both p less than 0.0001). Diltiazem's reduction of the frequency of episodes compared with placebo (2.3 versus 1.9 episodes/24 hr) was associated with a trend (p = 0.08) in the protocol-completed analysis and with a significant reduction in the intent-to-treat analysis (p = 0.03). Nifedipine had no significant effect on any measured variable of ambulatory ischemia. The dosages of medication used may have been excessive for some patients, and a more beneficial effect may have been evident at a lower dose. In contrast to the marked effects of the active agents on ambulatory asymptomatic ischemia, the effects on exercise performance and angina pectoris were slight. The active agents modestly improved treadmill exercise duration time until 1 mm ST segment depression (3%), and only propranolol and diltiazem had significant effects. Only diltiazem significantly prolonged the total exercise time. Anginal frequency was significantly decreased by both propranolol and diltiazem.(ABSTRACT TRUNCATED AT 400 WORDS)
登录
查看更多内容
硝苯地平治疗慢性稳定性心绞痛的多中心双盲、安慰剂对照研究的中期报告。
DOI：
10.1016/0002-9343(81)90229-1
发表时间：
1981
期刊：
The American journal of medicine
影响因子：
--
作者：
H. Mueller;R. Chahine
通讯作者：
R. Chahine
通过运动试验研究硝苯地平联合或不联合β受体阻滞剂的抗心绞痛功效。
影响因子：
2.7
作者：
L. Ekelund;L. Orö
通讯作者：
L. Orö
精神压力导致的无症状性心肌缺血
DOI：
10.1016/s0140-6736(84)91106-1
发表时间：
1984
期刊：
The Lancet
影响因子：
--
作者：
J. Deanfield;M. Kensett;R. Wilson;M. Shea;P. Horlock;C. Landsheere;A. Selwyn
通讯作者：
A. Selwyn
日常活动和压力期间心肌缺血。
DOI：
10.1016/0002-9149(86)90410-8
发表时间：
1986
期刊：
The American journal of cardiology
影响因子：
--
作者：
D. Tzivoni;A. Gavish;J. Benhorin;A. Keren;S. Stern
通讯作者：
S. Stern
β-受体阻滞剂和高血压患者冠心病的一级预防。
DOI：
--
发表时间：
1989
期刊：
JAMA : the journal of the American Medical Association
影响因子：
--
作者：
Psaty,BM;Koepsell,TD;LoGerfo,JP;Wagner,EH;Inui,TS
通讯作者：
Inui,TS