DILTIAZEM REDUCES RESTENOSIS AFTER PERCUTANEOUS TRANSLUMINAL CORONARYANGIOPLASTY

In a prospective, randomized, and double-blinded protocol, the effect of oral diltiazem (180 mg) over placebo on the restenosis rate was ass essed in 189 consecutive patients (150 males, 39 females, 57.6 +/- 8.4 years) eligible for follow-up angiography after 3.6 +/- 0.6 months (d iltiazem 90.4%, placebo 89.6%). Pre-PTCA stenoses were similar in both groups (diltiazem 83.9%; placebo 84.4%). Immediately after PTCA, the remaining stenoses were identical in both groups (22.6% vs 22.8%). At follow-up angiography there was a highly significant difference (P < 0 .01) in favor of diltiazem (minimal lumen diameter 38.6% vs 50.3%). Re stenosis rate (greater than or equal to 50% stenosis or loss of > 50% of the initial gain) was significantly (P < 0.03) reduced by diltiazem (18[21.4%] of 84 patients) compared to placebo (33 [38.4%] of 86 pati ents). Diltiazem was superior to placebo in all vessels: (1) left ante rior descending coronary artery: 21.6% vs. 32.7%, (2) right coronary a rtery: 25% vs 46.7%; and (3) left circumflex: 16.7% vs 36%. The benefi t of diltiazem was most pronounced in calcified plaques (33.3% vs 47.1 %), in diabetics (15% vs 46.2%), in hypercholesterolemia (20.4% vs 44. 2%, P < 0.05), in rite age range of 41-50 years (21.4% vs 44.4%), and in patients with CCS Class 2 (11.1% vs 64%, P < 0.01). In stratified a nalysis, the effect was apparent in both sexes, independent from conco mitant therapy, regardless of whether or nor coronary artery disease h ad progressed in segments other than the dilated ones. Thus, in this l imited series of patients, diltiazem significantly reduced the number and extent of restenosis. Confirmation in a larger cohort is necessary .