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A comparison of cilostazol and pentoxifylline for treating intermittent claudication

AMERICAN JOURNAL OF MEDICINE 2000年第7期109卷 523-530页

作者： Dawson, DL Cutler, BS Hiatt, WR Hobson, RW Martin, JD Bortey, EB Forbes, WP Strandness, DE Wilford Hall USAF Med Ctr Lackland AFB TX 78236 USA Univ Massachusetts Worcester MA 01605 USA Univ Colorado Hlth Sci Ctr Denver CO USA Univ Med & Dent New Jersey New Jersey Med Sch Newark NJ 07103 USA Otsuka Amer Pharmaceut Inc Rockville MD USA Univ Washington Seattle WA 98195 USA

PURPOSE: We performed a randomized, double-blind, placebo-controlled, multicenter trial to evaluate the relative efficacy and safety of cilostazol and pentoxifylline. PATIENTS AND METHODS: We enrolled patients with moderate-to-severe claudication from 54 outpatient vascular clinics, including sites at Air Force, Veterans Affairs, tertiary care, and university medical centers in the United States. Of 922 consenting patients, 698 met the inclusion criteria and were randomly assigned to blinded treatment with either cilostazol (100 mg orally twice a day), pentoxifylline (400 mg orally 3 times a day), or placebo. We measured maximal walking distance with constant-speed, variable-grade treadmill testing at baseline and at 4, 8, 12, 16, 20, and 24 weeks. RESULTS: Mean maximal walking distance of cilostazol-treated patients (n = 227) was significantly greater at every postbaseline visit compared with patients who received pentoxifylline (n = 232) or placebo (n = 239). After 24 weeks of treatment, mean maximal walking distance increased by a mean of 107 m (a mean percent increase of 54% from baseline) in the cilostazol group, significantly more than the 64-m improvement (a 30% mean percent increase) with pentoxifylline (P <0.001). The improvement with pentoxifylline was similar (P = 0.82) to that in the placebo group (65 m, a 34% mean percent increase). Deaths and serious adverse event rates were similar in each group. Side effects (including headache, palpitations, and diarrhea) were more common in the cilostazol-treated patients, but withdrawal rates were similar in the cilostazol (16%) and pentoxifylline (19%) groups. CONCLUSION: Cilostazol was significantly better than pentoxifylline or placebo for increasing walking distances in patients with intermittent claudication, but was associated with a greater frequency of minor side effects. Pentoxifylline and placebo had similar effects. Am J Med. 2000;109:523-530. (C) 2000 by Excerpta Medica, Inc.

关键词：双盲法用药计划表运动试验间歇性跛行/药物疗法己酮可可碱/投药和剂量己酮可可碱/治疗应用疾病严重程度指数四唑类/投药和剂量四唑类/治疗应用时间因素治疗结果血管舒张药/投药和剂量血管舒张药/治疗应用步行老年人女(雌)性人类男(雄)性中年人

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Carvedilol improves endothelium-dependent dilatation in patients with coronary artery disease

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AMERICAN HEART JOURNAL 2000年第5期140卷 753-759页

作者： Matsuda, Y Akita, H Terashima, M Shiga, N Kanazawa, K Yokoyama, M Kobe Univ Sch Med Dept Internal Med 1 Chuo Ku Kobe Hyogo 6500017 Japan

Objective Flow-mediated, endothelium-dependent dilatation (FMD) of the coronary and peripheral circulation is impaired by increased oxidative stress in patients with coronary artery disease (CAD). Carvedilol is a novel P-blocker that also shows an antioxidant effect in vitro. However, the effect of carvedilol on endothelial dysfunction associated with established coronary atherosclerosis has not been examined in the clinical setting. Methods We studied 29 patients with CAD, including 17 with recent myocardial infarction and 12 with stable effort angina pectoris. Nineteen patients received carvedilol (10 with infarction and 9 with angina), and 10 were treated with placebo (7 with infarction and 3 with angina). We also studied 13 age- and sex-matched control subjects. Brachial FMD during reactive hyperemia a nd nitroglycerin-induced, endothelium-independent dilatation were assessed by high-resolution ultrasound. Results FMD was smaller in patients with CAD com pa red with controls, although nitroglycerin-induced dilatation was similar. Carvedilol significantly improved FMD after long-term treatment (5.1% +/- 0.4% at baseline to 7.8% +/- 0.3% after 4 months;P <.01) but not after short-term treatment (5.1% +/- 0.4% at baseline to 5.0% +/- 0.7% after 2 hours). Placebo therapy had no effect on endothelial dysfunction. Neither carvedilol nor placebo had an effect on nitroglycerin-induced dilatation after short- and long-term treatment. Long-term carvedilol therapy also significantly decreased the plasma level of thiobarbituric acid-reactive substances compared with placebo (carvedilol, 5.8 +/- 0.4 nmol/ml to 4.6 +/- 0.3 nmol/ml, P <.01;placebo, 5.9 +/- 0.4 nmol/ml to 5.8 +/- 0.4 nmol/ml, P = not significant). Conclusion These findings suggest that the improvement of endothelial function by carvedilol may be caused by its antioxidant activity.

关键词：肾上腺素能β受体拮抗剂/治疗应用抗氧化剂/治疗应用卡唑类/治疗应用病例对照研究冠心病/血液冠心病/药物疗法冠心病/病因学冠心病/病理生理学内皮血管/药物作用内皮血管/病理生理学硝酸甘油/治疗应用丙醇胺类/治疗应用治疗结果血管舒张/药物作用血管舒张药/治疗应用女(雌)性人类男(雄)性中年人

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The effects of anti-hypertensive therapy on the structural, mechanical and metabolic properties of the rat aorta

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JOURNAL OF MUSCLE RESEARCH AND CELL MOTILITY 2000年第3期21卷 255-267页

作者： Clark, JF Radda, GK Boehm, EA Univ Oxford Dept Biochem Oxford OX1 3QU England

The vascular system exhibits altered growth, calcium responses and metabolism during hypertension. To relate such changes, we compared histological, tension and metabolic responses in the aorta from 32-week-old spontaneously hypertensive rats (SHRs), normotensive Wistar-Kyoto (WKY) rats, and SHRs treated with Verapamil (V) and ACE-inhibitor, Trandolapril (T) as well as a combination of the two treatments (C). Vascular hypertrophy was apparent in the SHRs. Contractile responses induced by 50 mmol/l KCl and 2.5 mmol/l Ca2+ were significantly lower in the SHR (64.4 mN/mm(2) vs. 49.2 mN/mm(2)), but an associated increase in Ca2+-sensitivity (EC50 of extracellular Ca2+ (mu mol/l): SHR, 456 vs. WKY, 616) normalised tension generating ability. All treatments led to significant decreases in blood pressure, although only T and C treated animals became normotensive with concomitant normalisation of vascular hypertrophy. An increase in oxygen consumption was apparent in the SHR aorta, which was associated with significant differences in the activities of key metabolic enzymes. Anti-hypertensive treatment normalised many of the metabolic parameters, with the C therapy being the most efficacious. We conclude that the treatment of hypertension by combined therapy leads to a better normalisation of structural, contractile, and metabolic parameters in the SHR, than either treatment alone and that metabolic changes with the pathology are resolved with appropriate therapy.

关键词：血管紧张素转换酶抑制药/药理学血管紧张素转换酶抑制药/治疗应用抗高血压药/药理学抗高血压药/治疗应用主动脉/药物作用主动脉/代谢主动脉/病理生理学高血压/药物疗法高血压/代谢高血压/病理生理学吲哚类/药理学吲哚类/治疗应用肌收缩/药物作用肌平滑血管/药物作用肌平滑血管/代谢肌平滑血管/病理生理学大鼠近交SHR 大鼠近交WKY 血管舒张药/药理学血管舒张药/治疗应用维拉帕米/药理学维拉帕米/治疗应用动物男(雄)性大鼠

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A novel mechanism for the beneficial vascular effects of high-density lipoprotein cholesterol:: Enhanced vasorelaxation and increased endothelial nitric oxide synthase expression

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AMERICAN HEART JOURNAL 2002年第1期144卷 165-172页

作者： Kuvin, JT Rämet, ME Patel, AR Pandian, NG Mendelsohn, ME Karas, RH Tufts Univ Sch Med New England Med Ctr Hosp Dept Med Boston MA 02111 USA Tufts Univ Sch Med New England Med Ctr Hosp Mol Cardiol Res Inst Boston MA 02111 USA

Background Low levels of high-density lipoprotein (HDL) cholesterol increase the risk of coronary artery disease (CAD), and recent clinical studies suggest that interventions in low-HDL patients are beneficial. The purpose of this study was to examine the effect of increased HDL levels on endothelium-dependent vasodilation. Methods We studied patients with CAD with a low-density lipoprotein (LDL) level of <100 mg/dL. Patients with an HDL level of greater than or equal to36 mg/dL were treated with niacin (n = 11), and patients with an HDL level of >36 mg/dL were followed as controls (n = 10). Baseline and 3-month follow-up studies of flow-mediated dilation (FMD) and blood lipid levels were obtained. Results HDL levels increased from 30.1 +/- 1.2 to 40.5 +/- 1.2 mg/dL in the niacin-treated patients (P <.001) but remained unchanged in the control patients. At baseline, FMD was impaired in both the treated (6.5% +/- 1 %) and the control (7.3% +/- 1%) patients compared with 10 healthy subjects (16% +/- 2%, P <.01). After 3 months, FMD improved in the niacin-treated patients (11.8% +/- 1 %, P =.001) but remained unchanged in the control patients (6.2% +/- 1 %). Exposure of cultured human vascular endothelial cells to HDL in vitro enhanced expression of endothelial nitric oxide synthase (eNOS), as shown by immunoblotting. Conclusions In patients with CAD and well-controlled LDL levels, elevation of HDL with niacin improves endothelial function. HDL increases eNOS protein expression in cultured vascular endothelial cells. Taken together, these observations suggest that HDL-mediated increases in eNOS expression may contribute to the observed enhancement in vasorelaxation and thus support a previously unrecognized mechanism for the beneficial cardiovascular effects of HDL.

关键词：降血脂药/治疗应用病例对照研究胆固醇 HDL/血液胆固醇 LDL/血液内皮血管/酶学内皮血管/生理学尼克酸/治疗应用一氧化氮合酶/代谢一氧化氮合酶Ⅲ型血管舒张/生理学血管舒张药/治疗应用女(雌)性人类男(雄)性中年人

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Neurohormonal activation in severe heart failure: Relations to patient death and the effect of treatment with flosequinan

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AMERICAN HEART JOURNAL 2000年第4期139卷 587-595页

作者： Moe, GW Rouleau, JL Charbonneau, L Proulx, G Arnold, JMO Hall, C de Champlain, J Barr, A Sirois, P Packer, M St Michaels Hosp Terrence Donnelly Heart Ctr Toronto ON M5B 1W8 Canada

Background Flosequinan is a direct-acting vasodilator that exerts beneficial hemodynamic effects and improves the exercise tolerance of patients with heart failure. However, a multicenter trial has demonstrated that long-term administration of flosequinan is associated with increased mortality rate. To explore a possible role of neurohormonal activation on this adverse outcome, we conducted a substudy to examine the plasma levels of 3 neurohormonal systems known to have prognostic implications in heart failure. Methods At 20 participating Canadian centers, paired plasma samples at baseline and 1 month after randomization for the measurement of N-terminal atrial natriuretic peptide (N-ANP), angiotensin Ii, and norepinephrine were obtained in 234 patients (114 receiving flosequinan and 120 receiving placebo). Results Treatment with flosequinan was associated with a decline in median plasma N-ANP levels (2139 pmol/L at base line to 1625 pmol/L at 1 month [P = .0001]), unchanged plasma angiotensin II levels (40 to 50 pmol/L [P = .2700]), and a modest increase in plasma norepinephrine levels (391 to 439 pg/mL [P = .002]). These changes were riot observed in the placebo group. Multivariate analysis of baseline variables revealed that plasma norepinephrine level predicted patients' death whereas analysis incorporating both baseline and 1-month variables indicated that plasma N-ANP level predicted patients' death. Furthermore, in the flosequinan group, a significant decline in plasma N-ANP level was observed in the survivors only. On multivariate analysis of baseline and 1-month data, the increase in plasma norepinephrine level did not predict the increase in heart rate associated with the use of flosequinan, suggesting that the 2 effects might be mediated by separate mechanisms. Conclusions Results of our study demonstrate that in patients with severe heart failure, baseline norepinephrine level pre diets death. Flosequinan increases plasma norepinephrine level and heart r

关键词：血管紧张素Ⅱ/生理学心钠素/生理学死亡原因队列研究去甲肾上腺素/生理学预后蛋白质前体/生理学喹啉类/治疗应用存活率血管舒张药/治疗应用老年人女(雌)性人类男(雄)性中年人

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Effect of folic acid and antioxidant vitamins on endothelial dysfunction in patients with coronary artery disease

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第3期36卷 758-765页

作者： Title, LM Cummings, PM Giddens, K Genest, JJ Nassar, BA Queen Elizabeth 2 Hlth Sci Ctr Div Cardiol Halifax NS B3H 3A7 Canada Queen Elizabeth 2 Hlth Sci Ctr Dept Lab Med & Pathol Halifax NS B3H 3A7 Canada Inst Rech Clin Montreal Montreal PQ H2W 1R7 Canada

OBJECTIVES The purpose of this study was to determine whether lowering homocysteine levels with folic acid, with or without antioxidants, will improve endothelial dysfunction in patients with coronary artery disease (CAD). BACKGROUND Elevated plasma homocysteine levels are a risk factor for atherosclerosis. Homocysteine may promote atherogenesis through endothelial dysfunction and oxidative stress. METHODS In a double-blind, placebo-controlled, randomized trial, we used vascular ultrasound to assess the effect of folic acid alone or with antioxidants on brachial artery endothelium-dependent flow-mediated dilation (FMD). Seventy-five patients with CAD (screening homocysteine level greater than or equal to 9 mu mol/liter) were randomized equally to one of three groups: placebo, folic acid alone or folic acid plus antioxidant vitamins C and E. Patients were treated for four months. RESULTS Plasma folate, homocysteine, FMD and nitroglycerin-mediated dilation were measured before and after four months of treatment. Plasma folate, homocysteine and FIL LD were unchanged in the placebo group. Compared with placebo, folic acid alone increased plasma folate by 475% (p < 0.001), reduced plasma homocysteine by 11% (p = 0.23) and significantly improved FMD from 3.2 +/- 3.6% to 5.2 +/- 3.9% (p = 0.04). The improvement in FMD correlated with the reduction in homocysteine (r = 0.5, p = 0.01). Folic acid plus antioxidants increased plasma folate by 438% (p < 0.001), reduced plasma homocysteine by 9% (p = 0.56) and insignificantly improved FR ID from 2.6 +/- 2.4% to 4.0 +/- 3.7% (p = 0.45), as compared with placebo. Nitroglycerin-mediated dilation did not change significantly in any group. CONCLUSIONS Folic acid supplementation significantly improved endothelial dysfunction in patients with coronary atherosclerosis. Further clinical trials are required to determine whether folic acid supplementation may reduce cardiovascular events. (C) 2000 by the American College of Cardiology.

关键词：抗氧化剂/副作用抗氧化剂/治疗应用抗坏血酸/副作用抗坏血酸/治疗应用血液循环冠心病/药物疗法冠心病/病理生理学双盲法内皮血管/药物作用内皮血管/病理生理学叶酸/副作用叶酸/治疗应用高半胱氨酸/血液脂类/血液丙二醛/血液硝酸甘油/治疗应用血管舒张血管舒张药/治疗应用维生素B12/血液维生素E/副作用维生素E/治疗应用老年人女(雌)性人类男(雄)性中年人

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Carvedilol prevents remodeling in patients with left ventricular dysfunction after acute myocardial infarction

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AMERICAN HEART JOURNAL 1999年第4期137卷 646-652页

作者： Senior, R Basu, S Kinsey, C Schaeffer, S Lahiri, A Northwick Pk & St Marks NHS Trust Hosp Dept Cardiovasc Med Harrow HA1 3UJ Middx England

Objective The aim of the study was to assess the effects of carvedilol, a vasodilating nonselective P-blocker, on the indexes of left ventricular remodeling after acute myocardial infarction in those with left ventricular dysfunction. Methods and Results Forty-nine patients with predischarge left ventricular election fraction <45% after acute myocardial infarction were evaluated in a double-blind, randomized, placebo-controlled, parallel group study (selected from the database of the Carvedilol Heart Attack Pilot Study: CHAPS). Patients received medication after thrombolysis and continued to do so for 6 months. Two-dimensional echocardiography was performed before discharge (7 to 10 days after admission) and at 3 months after acute myocardial infarction. Analysis of variance showed that wall thickness opposite the site of infarction decreased from (mean +/- SD) 12.3 +/- 2.1 mm to 11.0 +/- 2.4 mm with carvedilol compared with 11.6 +/- 1.9 mm to 12.2 +/- 1.9 mm with placebo (P = .01). left ventricular mass changed from 235 +/- 74 g to 217 +/- 64 g with carvedilol compared with 227 +/- 80 g to 252 +/- 85 g with placebo (P = .02). Carvedilol prevented alteration of sphericity index (ratio of long and short axis of left ventricle) that changed from 1.65 +/- 0.29 to 1.66 +/- 20 with carvedilol compared with 1.58 +/- 0.33 to 1.39 +/- 0.19 with placebo (P = .02);alteration was also prevented of wail thickening abnormality at infarct site, which changed from 9.2 +/- 3.1 cm(2) to 9.1 +/- 3.5 cm(2) with carvedilol compared with 10.3 +/- 3.3 cm(2) to 13.5 +/- 4.6 cm(2) with placebo (P = .002). Conclusion Carvedilol administered early after acute myocardial infarction results in attenuation of left ventricular remodeling in patients with persistent left ventricular dysfunction before discharge.

关键词：肾上腺素能β受体拮抗剂/药理学肾上腺素能β受体拮抗剂/治疗应用卡唑类/药理学卡唑类/治疗应用双盲法超声心动描记术心肌梗死/药物疗法丙醇胺类/药理学丙醇胺类/治疗应用治疗结果血管舒张药/药理学血管舒张药/治疗应用心室功能障碍左/病理生理学心室功能障碍左/超声检查心室重构/药物作用成年人老年人女(雌)性人类男(雄)性中年人

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The effect of withdrawal of drugs treating intermittent claudication

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AMERICAN JOURNAL OF SURGERY 1999年第2期178卷 141-146页

作者： Dawson, DL DeMaioribus, CA Hagino, RT Light, JT Bradley, DV Britt, KE Charles, BE Wilford Hall USAF Med Ctr Dept Gen Surg Surg Res Serv Lackland AFB TX 78236 USA

BACKGROUND: Pharmacologic treatment for intermittent claudication is a management option. This study evaluated the effect of withdrawal of drug therapies, cilostazol and pentoxifylline, on the walking ability of peripheral artery disease patients. METHODS: Single-blind placebo crossover from a randomized, double-blind trial;45 claudication patients received either cilostazol 100 mg orally twice daily (n = 16), pentoxifylline 400 mg orally three times daily (n = 13), or placebo (n = 16) for 24 weeks. After 24 weeks of double-blind therapy, treatment for all groups was placebo only, and follow-up continued through week 30. Treatment efficacy was established with treadmill testing. RESULTS: Profile analysis demonstrated a highly significant loss of treatment benefit after crossover (P = 0.001) for cilostazol-treated patients, but no significant change after crossover was observed with pentoxifylline. CONCLUSIONS: Drug withdrawal worsened the walking of claudicants who had benefited from cilostazol therapy. This decline with crossover to placebo suggests that the initial improvement with cilostazol treatment was due to the drug's action. Withdrawal of pentoxifylline did not adversely affect walking. Am J Surg. 1999;178: 141-146. (C) 1999 by Excerpta Medica, Inc.

关键词：投药口服交叉研究双盲法运动试验随访研究间歇性跛行/药物疗法间歇性跛行/病理生理学己酮可可碱/投药和剂量己酮可可碱/治疗应用安慰剂血小板聚集抑制剂/投药和剂量血小板聚集抑制剂/治疗应用单盲法四唑类/投药和剂量四唑类/治疗应用治疗结果血管舒张药/投药和剂量血管舒张药/治疗应用步行/生理学成年人老年人女(雌)性人类男(雄)性中年人

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Effects of the repeated administration of adenosine and heparin on myocardial perfusion in patients with chronic stable angina pectoris

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AMERICAN JOURNAL OF CARDIOLOGY 2000年第1期85卷 1-7页

作者： Barron, HV Sciammarella, MG Lenihan, K Michaels, AD Botvinick, EH Univ Calif San Francisco Dept Med Cardiol San Francisco CA 94143 USA Univ Calif San Francisco Dept Radiol Nucl Med San Francisco CA 94143 USA

The mechanism by which ischemia stimulates angiogenesis is unknown. Adenosine is released during myocardial ischemia and may be a mediator of this process. Experimental data suggest that heparin may enhance this effect. The purpose of this open-labeled, placebo-controlled trial was to determine whether repeated intravenous administration of adenosine and heparin could mimic physiologic angiogenesis and reduce the amount of exercise-induced myocardial ischemia in patients with coronary artery disease. Subjects with chronic stable angina refractory to conventional medical therapy and not suitable for revascularization received either adenosine (140 mu g/kg/min for 6 minutes) and heparin (10,000 U bolus), (n = 14), or placebo, (n = 9) daily for 10 days. All patients underwent baseline and follow-vp exercise testing with thallium-201 single-photon emission computed tomography myocardial perfusion imaging. A semiquantitative assessment of the extent and severity of the perfusion abnormalities was calculated by 2 blinded investigators. There was no significant change in exercise duration or in the peak heart rate systolic blood pressure product associated with adenosine and heparin compared with placebo treatment. There was, however, a 9% reduction in the extent (60.6 +/- 4.0 vs 54.9 +/- 4.1, p = 0.03) and a 14% improvement in severity (41.5 +/- 3.2 vs 35.7 +/- 2.9, p = 0.01) of the myocardial perfusion abnormalities seen in patients who received adenosine and heparin compared with placebo. Thus, in this pilot study, repeated administration of adenosine and heparin reduced the amount of exercise-induced ischemia in patients with chronic stable angina refractory to conventional treatment. (C) 2000 by Excerpta Medico, Inc.

关键词：腺苷/治疗应用心绞痛/并发症心绞痛/药物疗法抗凝药/治疗应用血压/药物作用慢性病侧支循环/药物作用药物疗法联合运动试验心率/药物作用肝素/治疗应用输注静脉内注射静脉内心肌缺血/分类心肌缺血/诊断心肌缺血/病因学心肌缺血/病理生理学新生血管化生理性/药物作用试点项目疾病严重程度指数单盲法心缩期铊放射性同位素/诊断应用体层摄影术发射型计算机单光子血管舒张药/治疗应用女(雌)性人类男(雄)性中年人

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Intravenous nicorandil can preserve microvascular integrity and myocardial viability in patients with reperfused anterior wall myocardial infarction

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第3期33卷 654-660页

作者： Ito, H Taniyama, Y Iwakura, K Nishikawa, N Masuyama, T Kuzuya, T Hori, M Higashino, Y Fujii, K Minamino, T Sakurabashi Watanabe Hosp Div Cardiol Kita Ku Osaka 5300001 Japan Osaka Univ Sch Med Dept Med 1 Osaka 553 Japan

OBJECTIVES We assessed whether the intravenous administration of nicorandil, an adenosine triphosphate (ATP)-sensitive K+ channel opener, exerts beneficial effect-on microvascular function and functional and clinical outcomes in patients with acute myocardial infarction (AMI). BACKGROUND Experimental studies documented that ATP-sensitive K+ channel opener exerts cardioprotection after prolonged ischemia. METHODS We randomly divided 81 patients with a first anterior AMI into two groups, nicorandil (n = 40) and control groups (n = 41). All patients received successful coronary angioplasty within 12 h after the symptom onset and underwent myocardial contrast echcardiography (MCE) with the intracoronary injection of sonicated microbubbles. In the nicorandil group, we injected 4 mg of nicorandil followed by the infusion at 6 mg/h for 24 h and by oral nicorandil (15 mg/day). RESULTS The improvement in regional left ventricular function, nail motion score and regional wall motion was significantly better in the nicorandil group then in the control group. Intractable congestive heart failure, malignant ventricular arrhythmia and pericardial effusion were more frequently found in the control group than in the nicorandil group (15% vs. 37%, 5% vs. 20% and 8% vs. 37%, p < 0.05, respectively). The frequency of sizable MCE no reflow phenomenon was significantly lower in the nicorandil group than in the control group (15% vs. 33%, p < 0.05). CONCLUSIONS Intravenous nicorandil in conjunction with coronary angioplasty is associated with better functional and clinical outcomes compared to angioplasty alone in patients with an anterior AMI. Myocardial contrast echocardiography findings imply that an improvement in microvascular function with nicorandil may be attributable to this better outcome. CT Am (C) 1999 by the American College of Cardiology.

关键词：血管成形术气囊冠状动脉冠状血管造影术冠状血管/药物作用冠状血管/病理生理学超声心动描记术随访研究心室/药物作用心室/代谢注射静脉内心肌收缩/药物作用心肌梗死/病因学心肌梗死/病理生理学心肌梗死/外科学心肌再灌注损伤/并发症心肌再灌注损伤/病理生理学尼可地尔/投药和剂量尼可地尔/治疗应用钾通道/药物作用钾通道/代谢预后放射性核素心室显像术回顾性研究钠钾交换ATP酶/药物作用钠钾交换ATP酶/代谢血管舒张药/投药和剂量血管舒张药/治疗应用女(雌)性人类男(雄)性中年人

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