The use of a calcium antagonist of the III generation Vaskopina a period of direct myocardial revascularization in elderly patients

The use of arterial grafts in coronary artery bypass surgery and coronary artery bypass graft-mammaro (CABG + MKSH), on the one hand, much povysiloi effectiveness of surgical intervention, with another - defined range of issues, ka-saving HIV medication support of the postoperative period.

If the standard protocol, including the appointment of clopidogrel, statins, ACE inhibitors, beta-blockers and nitrates, if necessary (with incomplete revascularization) is defined by (2,5,6,7), then the appointment of calcium antagonists - retardnyh forms II and III generation to prevent vasospastic reactions of arterial grafts is discussed (1.8). This is especially true of the elderly with concomitant hypertension and angina, vasospastic origin.

) у пациентов пожилого возраста с сопутствующей мягкой артериальной гипертензией (АГ) и склонностью к коронароспаз-му, перенесших прямую реваскуляризацию миокарда с использованием артериальных графтов. The aim of this work - a feasibility study of a calcium antagonist of the third generation - amlodipine (Vaskopina) in elderly patients with concomitant mild hypertension (AH) and a tendency to koronarospaz th undergoing direct myocardial revascularization using arterial grafts.

The study included 24 patients with ischemic heart disease (CHD), sub-vergshihsya bypass surgery + MKSH. With accompanying mild hypertension and coronary insufficiency with episodes of angina as a load, and vasospastic gene-for, with lipid metabolism disorders are not above the boundary phase. . The number of grafts averaged 4.3 + 0.7. In all patients, revascularization was incomplete due to the nature of coronary lesions. All patients received medical therapy, including clopidogrel, 75 mg, aspirin 75 mg, atorvastatin (Trovan), 10 mg, enalapril in a dose-5.10 mg, atenolol at a dose of 25-50 mg. Study group comprised 15 patients (10 women and 5 men: mean age of 68, 4 + 2.1 years) that the scheme was included postoperative calcium channel blocker amlodipine generation III (Vaskopin, the company ╚Pharmacare╩), the initial dose of 2 5 mg control group consisted of 9 patients (6 females and 3 males: mean age of 69, 4 + 3.2 years) who are not appointed by the AK. In the long-acting nitrates at the time of appointment Vaskopina needed in the postoperative period 12 (80%) patients had primary and 7 (78%) of the control group.

The study protocol included daily monitoring of systolic (SBP) and diastolic blood pressure (DBP), monitoring of performance in the operation (in stoperatsionnaya angina, dysfunction of the graft, the need for nitrates, progression-tion with the need to further atreroskleroza stenting or repeat revascularization, myocardial infarction, coronary death). Controlled by the efficiency of the antithrombotic and lipid-lowering therapy (study of platelet aggregation in platelet aggregation analyzer RA-2110 and the state of the lipid-exchange spectrophotometric method using a standard set of firm "Cormay"). State of the microcirculation was assessed using the conjunctive-tivalnoy biomicroscopy (HPA) with the determination of the partial co-konyuktivalny sudistogo (PIRT) and intravascular (PKVSI) indices. Assessment of the indicators of trans-port of oxygen was performed by noninvasive oximetry in the sample with of the local ischemia using the oxygen monitor SCI 2. Shunt function was determined by ultrasound studies. The survey was carried out before and after 3 and 6 months' after the appointment Vaskopina.

в данном исследовании прежде всего была способность этого препарата расслаблять глад-кую мускулатуру стенок артерий мышечного типа и артериол и, таким образом, умень-шать общее периферическое сосудистое сопротивление и предотвращать вазоспастиче-ские реакции(4,8), наличие которых было инструментально установлено в дооперацион-ном периоде. The basis for the use of a calcium antagonist of the III generation - Vaskopina in this study primarily was the ability of this drug to relax the smooth muscles of the arteries Kuyu muscle type and arterioles and, thus, reducing the shat total peripheral vascular resistance and prevent vazospastiche-skie reaction (4, 8), whose presence was instrumental in the preoperative set-rated period. Also take into account a number of studies revealed the ability of di-gidropiridinovyh derivatives reduce atherogenicity of blood plasma, improve Tole rantnost to glucose, a positive effect on natriuresis (4,5,9).

The table shows the dynamics of SBP, DBP, integral indicators of micro-circulatory channels that reflect the state of the vascular and intravascular compartments of tissue oxygen supply, the state of the lipid and carbohydrate metabolism in patients of the main and control groups. 9 patients of the main group for 6 months Vaskopin took a dose of 2.5 mg, six patients the dose was increased to 5 mg a day for relief of vasospastic angina. ). As can be seen from the table, the inclusion of post-operative management of patients Vaskopina scheme has helped to stabilize the pressure at the target level is more effective to correct microcirculatory disorders, to reach a higher saturation of oxygen to tissues and enhance the lipid-lowering therapy, conducted in both groups, atorvastatin (Trovanom).

Table. The dynamics of blood pressure, indicators of microcirculation, lipid and carbohydrate metabolism in primary (n = 15) and control (n = 9) groups

Note. Differences were significant in relation to baseline values ​​at a significance level: * p <0,05, ** p <0,01, *** p <0,001

Appointment Vaskopina significantly reduced the number of cases of vasospastic angina in the intervention group: 9 patients at follow-daily ECG monitoring (3 months) episodes of ST-segment elevation, but not registered. In 6 patients, and after controlling for study drug dose was increased to 5 mg, which made it possible to adjust coronary insufficiency vasospastic origin in 5 (83.3%) of them.

Of the 15 patients of the main group taking nitrates at 6-month observation resorted 3 (20%). In the control group at 6-month observation method of nitrate in the postoperative period due to the presence of angina as a load, and all in the nature of continued zospasticheskogo 5 (55.5%) patients.

Patency of bypass grafts mammarokoronarnyh by ultrasonography at 3 and 6 months in the main and control groups was 61.3 + 4.8 ml / min, 67.2 + 4.6 ml / min and 55.4 + 3.8 ml / min, 59.8 + 3.7 ml / min, respectively (p <0,05). Deaths in the comparison groups were not observed. One patient (11.1%) of the control group, in which excitation-Vratna angina in combination with a bulk velocity of blood flow in MKSH least 45 ml / min.otmechalas in the early postoperative period, underwent intervention (angioplasty and stenting). As for efficiency, antitrom boticheskoy therapy, it was productive as a whole in both groups, as evidenced by the results of controlled trials agregatogramm and MSC (no mikrotrombozov in arterioles), due to the positive influence of aspirin and clopidogrel.

Vaskopin well tolerated as a daily dose as 2.5 and 5 mg, to achieve and maintain target levels of blood pressure, control blood pressure morning. Deserves attention marked reduction meteozavisimosti fact patients (decrease in frequency of cold shenii anginal attacks and lifts blood pressure) on the background of combination therapy, which is consistent with the data of (3). Application Vaskopina allowed to stop taking nitrates in 60% of patients, increased the effectiveness of lipid-lowering therapy.

The results obtained in this study, data indicate the feasibility STI include amlodipine (Vaskopina) in the scheme of postoperative management of elderly patients with concomitant hypertension and a tendency to vasospasm.

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