Prostaglandin E₁ during angioplasty as preventative therapy for coronary restenosis

The effect of intravenous prostaglandin E₁ (PGE₁) on the incidence of restenosis after elective percutaneous transluminal coronary angioplasty (PTCA) was studied in a prospective, single-blind, randomized trial of 30 patients. Group I (12 patients) received only the conventional medications before and after protocol, and group II (18 patients) received intravenous PGE₁ influsion for 24 hours starting at least 2 hours before angiography after hemodynamically based titration to a mean dosage of 16 ± 3 ng/kg/min (range, 10-20 ng/kg/min). All patients received aspirin orally, beginning 24 hours before PTCA and continuing for 6 months, and intravenous heparin at 1000 U/h for 24 hours commencing with the beginning of catheterization before PTCA. Recatheterization was performed routinely at 6 months after PTCA, or earlier when clinically indicated. Angiographic evaluations were made by both visual and quantitative assessment. No significant side effects of PGE₁ treatment were observed. Only 17% of patients treated by PGE₁ experienced angina pectoris during 6-month follow-up period, as compared with 42% of patients who received conventional treatment (p = 0.13). Re-PTCA was more frequent in patients receiving conventional therapy than in those receiving PGE₁ (42% versus 11%; p = 0.06). The use of PGE₁ during PTCA was associated with 17% restenosis (both by computer and by visual evaluation) 6 months post-PTCA as compared with 33% and 50% restenosis (by computer and by visual evaluations, respectively) in the conventional group (p < 0.05). In conclusion, PGE₁ appears to decrease coronary restenosis 6 months after PTCA.