| The radial artery access, as the first choice, for coronary angiography and intervention has been widely accepted all around the world with its fewer local complications, major bleedings, ischemic events, and major adverse events at the same time, similar rates of procedural success, but one of the complications of the radial artery access, radial spasm, always make the patient painful, and even make the operation failed. Though with the development of the relevant research, radial spasm during the CAG and PCI has decreased remarkably, the rate of radial spasm remains a certain degree. β-receptor blockers were always used in coronary heart disease. Some scholarships hold the idea that β-receptor blockers, which can make the smooth muscle easier to be spasm, in other words, make the radial artery, a kind of artery composed of smooth muscle and other tissues, tend to be spasm, is one of the factors that induces the radial artery happen. However, some hold the opinion that the human radial artery is a kind of α-adrenoceptor dominant artery with little β-adrenoceptor function, so the use of β-blockers will not likely evoke the spasm of the radial artery. But there was no definite clinical trial, so far, to clarify whether the β-blockers can evoke the radial spasm or not. Then our research used the tartrate metoprolol, a kind ofβ-blocker, to illuminate that question and found the advanced theory foundation of the radial spasm prevention.Objectives: To clarify whether the tartrate metoprolol can evoke the radial spasm during the percutaneous coronary approach.Methods: A randomized controlled trial was designed and 175 consecutive cases, from July 2014 to February 2015, diagnosed as Non-ST-Elevation Acute Coronary Syndrome(NSTEACS) according the 2012 ACCF/AHA the Guideline for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction was admitted. All the patients received the general medications, including vessel-dilation treatment, anticoagulation and anti-aggregation therapy, and would be evaluated sufficiency before the coronary angiography and intervention, containing Allen’s trial, heart rate and blood pressure monitoring, the platelet aggregation rate measurements as well as the radial diameter and characteristics which were performed by the same experienced doctor. 30 minutes before the operation, the patients in control group were administrated with a sublingual placebo tablet, whereas patients in experimental group were given 25 mg tartrate metoprolol, and the heart rate, blood pressure were recorded subsequently. The coronary angiography and intervention adopted the transradial route, and the radial cannulation was performed by the same professional team with seldinger’s method, after the local anesthesia with 1 ml of 2% lidocaine was given. The 6F or 7F hydrophilic coating of the introducer sheath(TERUMO) was then inserted and 200 mg diluted nitroglycerin were slowly administered through it with 3000 U heparin together. The 4F catheters were used for coronary angiography. The needles, minutes of the radial puncture, minutes of the operation lasted and the radial spasm rate were recorded. Statistical analysis was performed by SPSS software(version 13.0 for Windows). Continuous variables were expressed as mean ± sd when they subject to normal distribution, or percentile. The categorical variables were expressed as absolute values and percentages. The distribution of the variables was assessed by using a one-sample Kolmogorov–Smirnov test. Continuous variables were compared using one-factor analysis of variance and Mann–Whitney U test, as appropriate. Differences between categorical variables were examined using the chi-square test. A P value of <0.05 was considered statistically significant.Results: 175 patients, numbered when admitted, were randomized into tartrate metoprolol group(experimental group, n=87) and placebo group(control group, n=88). 5 patients(2.8%, 2cases in experiment group, 3cases in control group), were excluded from the trial in terms of the radial access failed, which was induced by the Non-radial spasm factors. There were no differences between groups in regard to baseline clinical variables: age, gender, smoke, body mass index, radial diameter, the ratio between the sheath and radial diameter, diabetes mellitus, treatments including nitrates, calcium-antagonists and ACE inhibitors, as well as the needles, minutes of the radial puncture, minutes of the operation lasted and heparin dosages.(P>0.05)1 Spasm incidence: control group vs. experimental group: 8.2% vs. 3.5%, P=0.192. There were no significant differences between the two groups.2 On the hand of tartrate metoprolol using dosage: the control group < the experimental group: P25=12.5mg, P50=25mg, P75=25mg < P25=25mg,P50=25mg,P75=50mg, P<0.01, and the differences were significant.3 The metoprolol decreased the change of the heart rate from the usual time to at the beginning of the operation: the control group was P25=2bpm,P75=13bpm, higher than the metoprolol group:P25=-1 bpm, P75=8 bpm( P<0.01).4 Follow-up(30±2 days) evaluation of the radial artery patency by ultra sound and Allen’s test showed no differences between the two groups in the rate of radial occlusion(2.4% vs. 1.2%in the placebo and tartrate metoprolol treated patients, respectively).Conclusion: There was no relationship between tartrate metoprolol and radial artery spasm during the transradial approach, in other words, it may not likely make the radial to spasm. |
PDF Full Text Request