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European Heart Journal 1992 13(11):1534-1539;
Copyright © 1992 by the European Society of Cardiology.
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© 1992 The European Society of Cardiology

Usefulness of intracoronary isosorbide dinitrate in alleviating myocardial ischaemia during coronary balloon angioplasty

B. S. LEWIS, D. A. HALON, A. MERDLER, N. MAKHOUL, S. AFRIAT and A. SCHNEEWEISS

Received 18 December 1991; revised 13 May 1992; .

Correspondence. Basil S. Lewis, MD, FRCP, Department of Cardiology, Lady Davis Carmel Hospital, 7 Michal Street, Haifa 34362, Israel

Abstract

The effect of intracoronary isosorbide dinitrate on provoked myocardial ischaemia during percutaneous transluminal coronary angioplasty (PTC A) was studied in 60 patients who had at least 1 mm electrocardiographic (ECG) ST segment deviation during a 70 s control balloon inflation period. Isosorbide dinitrate (dose 1 mg, 2 mg or 3 mg) or placebo (saline) was administered by slow intracoronary injection, and the ST segment changes recorded again during an identical dilatation period 2–4 min later. Following injection of isosorbide dinitrate, the severity of ST segment deviation decreased (1 mg –31±30%, P = 0·03; 2mg -51±35%, P = 0·0001; 3mg –36±32%, P = 0·002) during coronary balloon inflation, and the time until onset of 1 mm ST deviation was prolonged (1 mg +79 ±137%, P = 0·06; 2 mg+85 ±87%, P = 0·02; 3mg+78± 109%, P = 0·02). With the 3 mg dose, the time to maximum ECG change increased (+37±87%, P = 0·02). In the placebo group, there was a small decrease in the severity of ST segment deviation in patients receiving placebo ( –23± 32%, P = 0·03), but no change in the time to its onset or in the time to maximum ST deviation.

Isosorbide dinitrate did not alter heart rate, systolic arterial pressure or the rate-pressure product at maximum ST segment change, implying that when isosorbide was administered by direct intracoronary injection, a direct cardiac effect was responsible for the major anti-ischaemic effect of the drug. The salutary effect of isosorbide dinitrate was far greater in the subset of patients who did not have a pre-existing angiographically visible collateral circulation to the distal coronary arterial segment.

Key Words: Nitrates • coronary angioplasty • myocardial ischaemia


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