Skip to main content
NCBI home page
British Heart Journal logoLink to British Heart Journal
. 1994 Mar;71(3):254–260. doi: 10.1136/hrt.71.3.254

Verapamil treatment after coronary angioplasty in patients at high risk of recurrent stenosis.

E Hoberg 1, R Dietz 1, U Frees 1, H A Katus 1, B Rauch 1, A Schömig 1, G Schuler 1, F Schwarz 1, H Tillmanns 1, J Niebauer 1, et al.
PMCID: PMC483663  PMID: 8142195

Abstract

OBJECTIVE--To evaluate the efficacy of high-dose verapamil treatment (240 mg twice daily) in the prevention of angiographic restenosis after primary successful coronary angioplasty in patients at high risk of recurrent obstruction. DESIGN--A placebo controlled, double blind trial in which patients with stable angina pectoris and patients with unstable angina or non-Q wave infarction treated with 330 mg aspirin and 75 mg dipyridamole twice daily were randomised to a verapamil group or a control group. Follow up angiography was performed 6 months after angioplasty or sooner if signs of recurrent ischaemia developed. SETTING--University department of cardiology. PATIENTS--196 consecutive patients undergoing coronary angioplasty from the beginning of April 1987 to the end of March 1989 and meeting the selection criteria that included the presence of at least one of six predefined risk factors for restenosis. At the time of coronary angioplasty 113 patients had unstable angina or non-Q wave infarction and 83 had stable angina pectoris. RESULTS--In 89 (91%) patients in the verapamil group and in 83 (85%) control patients follow up angiograms were available. The restenosis rate was lower in the verapamil group (48.3%) than in the placebo group (62.7%) (odds ratio 0.56, 95% confidence interval (CI) 0.303 to 1.025 p = 0.059). Of the 172 patients in whom follow up angiograms were available, 24 (13 taking verapamil and 11 taking placebo) did not comply with the trial for more than 40 (34) days (mean (1 SD)). For the remaining 148 patients the restenosis rate was 47.4% in the verapamil group and 63.9% in the placebo group (odds ratio 0.52, 95% CI 0.271 to 0.993, p = 0.046). In the 97 patients with unstable angina or non-Q wave infarction the restenosis rate was not significantly influenced by verapamil (55.8% with verapamil v 62.2% with placebo, odds ratio 0.77, 95% CI 0.339 to 1.728, p = 0.520). In the 75 patients with stable angina pectoris the restenosis rate dropped from 63.2% with placebo to 37.8% with verapamil (odds ratio 0.36, 95% CI 0.137 to 0.917, p = 0.038). CONCLUSION--The observed beneficial effect of high-dose verapamil treatment on the angiographic restenosis rate in patients with stable angina pectoris and at increased risk of recurrent obstruction requires confirmation in further prospective studies.

Full text

PDF
254

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Beatt K. J., Serruys P. W., Hugenholtz P. G. Restenosis after coronary angioplasty: new standards for clinical studies. J Am Coll Cardiol. 1990 Feb;15(2):491–498. doi: 10.1016/s0735-1097(10)80081-6. [DOI] [PubMed] [Google Scholar]
  2. Bertrand M. E., LaBlanche J. M., Thieuleux F. A., Fourrier J. L., Traisnel G., Asseman P. Comparative results of percutaneous transluminal coronary angioplasty in patients with dynamic versus fixed coronary stenosis. J Am Coll Cardiol. 1986 Sep;8(3):504–508. doi: 10.1016/s0735-1097(86)80174-7. [DOI] [PubMed] [Google Scholar]
  3. Block L. H., Emmons L. R., Vogt E., Sachinidis A., Vetter W., Hoppe J. Ca2+-channel blockers inhibit the action of recombinant platelet-derived growth factor in vascular smooth muscle cells. Proc Natl Acad Sci U S A. 1989 Apr;86(7):2388–2392. doi: 10.1073/pnas.86.7.2388. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Clowes A. W., Schwartz S. M. Significance of quiescent smooth muscle migration in the injured rat carotid artery. Circ Res. 1985 Jan;56(1):139–145. doi: 10.1161/01.res.56.1.139. [DOI] [PubMed] [Google Scholar]
  5. Corcos T., David P. R., Val P. G., Renkin J., Dangoisse V., Rapold H. G., Bourassa M. G. Failure of diltiazem to prevent restenosis after percutaneous transluminal coronary angioplasty. Am Heart J. 1985 May;109(5 Pt 1):926–931. doi: 10.1016/0002-8703(85)90231-5. [DOI] [PubMed] [Google Scholar]
  6. Grüntzig A. R., Senning A., Siegenthaler W. E. Nonoperative dilatation of coronary-artery stenosis: percutaneous transluminal coronary angioplasty. N Engl J Med. 1979 Jul 12;301(2):61–68. doi: 10.1056/NEJM197907123010201. [DOI] [PubMed] [Google Scholar]
  7. Heusch G. Alpha-adrenergic mechanisms in myocardial ischemia. Circulation. 1990 Jan;81(1):1–13. doi: 10.1161/01.cir.81.1.1. [DOI] [PubMed] [Google Scholar]
  8. Ip J. H., Fuster V., Badimon L., Badimon J., Taubman M. B., Chesebro J. H. Syndromes of accelerated atherosclerosis: role of vascular injury and smooth muscle cell proliferation. J Am Coll Cardiol. 1990 Jun;15(7):1667–1687. doi: 10.1016/0735-1097(90)92845-s. [DOI] [PubMed] [Google Scholar]
  9. Jackson C. L., Bush R. C., Bowyer D. E. Inhibitory effect of calcium antagonists on balloon catheter-induced arterial smooth muscle cell proliferation and lesion size. Atherosclerosis. 1988 Feb;69(2-3):115–122. doi: 10.1016/0021-9150(88)90004-4. [DOI] [PubMed] [Google Scholar]
  10. Kaltenbach M., Kober G., Scherer D., Vallbracht C. Recurrence rate after successful coronary angioplasty. Eur Heart J. 1985 Mar;6(3):276–281. doi: 10.1093/oxfordjournals.eurheartj.a061852. [DOI] [PubMed] [Google Scholar]
  11. Lambert M., Bonan R., Côté G., Crépeau J., de Guise P., Lespérance J., David P. R., Waters D. D. Multiple coronary angioplasty: a model to discriminate systemic and procedural factors related to restenosis. J Am Coll Cardiol. 1988 Aug;12(2):310–314. doi: 10.1016/0735-1097(88)90399-3. [DOI] [PubMed] [Google Scholar]
  12. Leimgruber P. P., Roubin G. S., Hollman J., Cotsonis G. A., Meier B., Douglas J. S., King S. B., Jr, Gruentzig A. R. Restenosis after successful coronary angioplasty in patients with single-vessel disease. Circulation. 1986 Apr;73(4):710–717. doi: 10.1161/01.cir.73.4.710. [DOI] [PubMed] [Google Scholar]
  13. Levine S., Ewels C. J., Rosing D. R., Kent K. M. Coronary angioplasty: clinical and angiographic follow-up. Am J Cardiol. 1985 Mar 1;55(6):673–676. doi: 10.1016/0002-9149(85)90134-1. [DOI] [PubMed] [Google Scholar]
  14. Liu M. W., Roubin G. S., King S. B., 3rd Restenosis after coronary angioplasty. Potential biologic determinants and role of intimal hyperplasia. Circulation. 1989 Jun;79(6):1374–1387. doi: 10.1161/01.cir.79.6.1374. [DOI] [PubMed] [Google Scholar]
  15. Mabin T. A., Holmes D. R., Jr, Smith H. C., Vlietstra R. E., Reeder G. S., Bresnahan J. F., Bove A. A., Hammes L. N., Elveback L. R., Orszulak T. A. Follow-up clinical results in patients undergoing percutaneous transluminal coronary angioplasty. Circulation. 1985 Apr;71(4):754–760. doi: 10.1161/01.cir.71.4.754. [DOI] [PubMed] [Google Scholar]
  16. Mata L. A., Bosch X., David P. R., Rapold H. J., Corcos T., Bourassa M. G. Clinical and angiographic assessment 6 months after double vessel percutaneous coronary angioplasty. J Am Coll Cardiol. 1985 Dec;6(6):1239–1244. doi: 10.1016/s0735-1097(85)80208-4. [DOI] [PubMed] [Google Scholar]
  17. Nobuyoshi M., Kimura T., Nosaka H., Mioka S., Ueno K., Yokoi H., Hamasaki N., Horiuchi H., Ohishi H. Restenosis after successful percutaneous transluminal coronary angioplasty: serial angiographic follow-up of 229 patients. J Am Coll Cardiol. 1988 Sep;12(3):616–623. doi: 10.1016/s0735-1097(88)80046-9. [DOI] [PubMed] [Google Scholar]
  18. Nomoto A., Hirosumi J., Sekiguchi C., Mutoh S., Yamaguchi I., Aoki H. Antiatherogenic activity of FR34235 (Nilvadipine), a new potent calcium antagonist. Effect on cuff-induced intimal thickening of rabbit carotid artery. Atherosclerosis. 1987 Apr;64(2-3):255–261. doi: 10.1016/0021-9150(87)90253-x. [DOI] [PubMed] [Google Scholar]
  19. O'Keefe J. H., Jr, Giorgi L. V., Hartzler G. O., Good T. H., Ligon R. W., Webb D. L., McCallister B. D. Effects of diltiazem on complications and restenosis after coronary angioplasty. Am J Cardiol. 1991 Feb 15;67(5):373–376. doi: 10.1016/0002-9149(91)90044-l. [DOI] [PubMed] [Google Scholar]
  20. Salerno D. M., Granrud G., Sharkey P., Asinger R., Hodges M. A controlled trial of propafenone for treatment of frequent and repetitive ventricular premature complexes. Am J Cardiol. 1984 Jan 1;53(1):77–83. doi: 10.1016/0002-9149(84)90687-8. [DOI] [PubMed] [Google Scholar]
  21. Schuler G., Hambrecht R., Schlierf G., Niebauer J., Hauer K., Neumann J., Hoberg E., Drinkmann A., Bacher F., Grunze M. Regular physical exercise and low-fat diet. Effects on progression of coronary artery disease. Circulation. 1992 Jul;86(1):1–11. doi: 10.1161/01.cir.86.1.1. [DOI] [PubMed] [Google Scholar]
  22. Schwartz L., Bourassa M. G., Lespérance J., Aldridge H. E., Kazim F., Salvatori V. A., Henderson M., Bonan R., David P. R. Aspirin and dipyridamole in the prevention of restenosis after percutaneous transluminal coronary angioplasty. N Engl J Med. 1988 Jun 30;318(26):1714–1719. doi: 10.1056/NEJM198806303182603. [DOI] [PubMed] [Google Scholar]
  23. Schwarz F., Tillmanns H., Schuler G., Mehmel H. C., Dietz R., Schaefer K., Hoberg E., Kübler W. Ballondilatation bei instabiler Angina pectoris und akutem Herzinfarkt. Dtsch Med Wochenschr. 1987 Dec 18;112(51-52):1973–1976. doi: 10.1055/s-2008-1068363. [DOI] [PubMed] [Google Scholar]
  24. Serruys P. W., Luijten H. E., Beatt K. J., Geuskens R., de Feyter P. J., van den Brand M., Reiber J. H., ten Katen H. J., van Es G. A., Hugenholtz P. G. Incidence of restenosis after successful coronary angioplasty: a time-related phenomenon. A quantitative angiographic study in 342 consecutive patients at 1, 2, 3, and 4 months. Circulation. 1988 Feb;77(2):361–371. doi: 10.1161/01.cir.77.2.361. [DOI] [PubMed] [Google Scholar]
  25. Sherman C. T., Litvack F., Grundfest W., Lee M., Hickey A., Chaux A., Kass R., Blanche C., Matloff J., Morgenstern L. Coronary angioscopy in patients with unstable angina pectoris. N Engl J Med. 1986 Oct 9;315(15):913–919. doi: 10.1056/NEJM198610093151501. [DOI] [PubMed] [Google Scholar]
  26. Simpfendorfer C., Belardi J., Bellamy G., Galan K., Franco I., Hollman J. Frequency, management and follow-up of patients with acute coronary occlusions after percutaneous transluminal coronary angioplasty. Am J Cardiol. 1987 Feb 1;59(4):267–269. doi: 10.1016/0002-9149(87)90797-1. [DOI] [PubMed] [Google Scholar]
  27. Stein O., Halperin G., Stein Y. Long-term effects of verapamil on aortic smooth muscle cells cultured in the presence of hypercholesterolemic serum. Arteriosclerosis. 1987 Nov-Dec;7(6):585–592. doi: 10.1161/01.atv.7.6.585. [DOI] [PubMed] [Google Scholar]
  28. Stiles C. D., Pledger W. J., Tucker R. W., Martin R. G., Scher C. D. Regulation of the Balb/c-3T3 cell cycle-effects of growth factors. J Supramol Struct. 1980;13(4):489–499. doi: 10.1002/jss.400130408. [DOI] [PubMed] [Google Scholar]
  29. Talley J. D., Weintraub W. S., Roubin G. S., Douglas J. S., Jr, Anderson H. V., Jones E. L., Morris D. C., Liberman H. A., Craver J. M., Guyton R. A. Failed elective percutaneous transluminal coronary angioplasty requiring coronary artery bypass surgery. In-hospital and late clinical outcome at 5 years. Circulation. 1990 Oct;82(4):1203–1213. doi: 10.1161/01.cir.82.4.1203. [DOI] [PubMed] [Google Scholar]
  30. Whitworth H. B., Roubin G. S., Hollman J., Meier B., Leimgruber P. P., Douglas J. S., Jr, King S. B., 3rd, Gruentzig A. R. Effect of nifedipine on recurrent stenosis after percutaneous transluminal coronary angioplasty. J Am Coll Cardiol. 1986 Dec;8(6):1271–1276. doi: 10.1016/s0735-1097(86)80296-0. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES