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Diltiazem provides anti-ischemic and anti-arrhythmic protection inpatients undergoing coronary bypass grafting

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In 91 patients undergoing elective coronary bypass grafting, the anti-ischemic and anti-arrhythmic efficacy of a 24-hour infusion of either thecalcium antagonist diltiazem (0.1 mg/kg per h, n = 44) or nitroglycerin (1micrograms/kg per min, n = 47) were compared. Myocardial ischemia wasdiagnosed by Holter monitoring and the repeated assessment of 12-lead ECGand serum enzyme levels and defined as a transient ischemic event,transient coronary spasm or myocardial infarction. The two groups did notdiffer with respect to preoperative and operative data. Postoperatively,the average heart rate and pulse pressure rate were significantly lower inthe diltiazem group. The incidence of postoperative atrial fibrillation(4.5 vs 19.1%, P < 0.01), transient coronary spasm (2.3 vs 11.4%, P <0.05) and myocardial infarction (4.5 vs 8.5%, not significant) and thefrequency of ventricular premature couplets/h (12.1 +/- 4.5 vs 18.1 +/-5.1, P < 0.05) and ventricular runs/h (2.5 +/- 0.8 vs 6.5 +/- 2.8, P< 0.05) were lower in the diltiazem as compared to the nitroglyceringroup. In addition, diltiazem-treated patients had significantly lowerpostoperative peak values of creatine kinase-MB (19.3 +/- 11.6 vs 29.3 +/-20.6, P < 0.05). In conclusion, perioperative infusion of diltiazem iseffective in reducing the incidence and extent of arrhythmias andmyocardial ischemia in patients undergoing elective coronary bypassgrafting as compared to patients receiving nitroglycerin.

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