Reduction of infarct size in patients with inferior infarction with intravenous glyceryl trinitrate. A randomised study.

Glyceryl trinitrate was previously said to be contraindicated in patients with acute myocardial infarction. Its intravenous administration during acute infarction, however, was associated with a beneficial effect as determined by ST segment mapping. Most recently in a selected group of patients with acute infarction and abnormal haemodynamics, intravenous glyceryl trinitrate was shown to reduce infarct size estimated by enzymes. The present study was performed to verify the safety of intravenous glyceryl trinitrate in patients with infarction under conventional clinical conditions without invasive monitoring and to determine its effect on infarct size in a prospective randomised trial involving 85 patients with infarction (43 treated and 42 control). Treated patients received glyceryl trinitrate within 10 hours of the onset of symptoms (mean 6.0 hours), and the dose was titrated to preset limits for changes in heart rate and blood pressure. In patients with inferior infarction, infarct size estimated by enzymes in the treated was only 12.2 +/- 1.8 versus 19.1 +/- 3.6 CK gram equivalents per metre squared in the placebo group. A similar but statistically insignificant trend was observed for subendocardial infarction but no difference was observed for anterior infarction. Ventricular arrhythmias determined from 24 hour tapes were more frequent in treated patients though this was not statistically significant. Lignocaine requirements in treated and control (1692 +/- 250 vs 1512 +/- 232 mg/24 h) were similar, as were the requirements for morphine (11.4 +/- 1.8 vs 12.2 +/- 2.2 mg/24 h). Results indicate that intravenous glyceryl trinitrate can be administered safely during evolving infarction without invasive monitoring and reduces infarct size in patients with inferior infarction.

[1]  R. Lindquist.  Bussmann WD, Passek D, Seidel W, Kaltenbach M. Reduction of CK and CK‐MB indexes of infarct size by intravenous nitroglycerin. Circulation 1981;63: 615 , 1982 .

[2]  B. Sobel,et al.  Functional Response of the Right Ventricle to Myocardial Infarction: Dependence on the Site of Left Ventricular Infarction , 1981, Circulation.

[3]  W. Seidel,et al.  Reduction of CK and CK‐MB Indexes of Infarct Size by Intravenous Nitroglycerin , 1981, Circulation.

[4]  L. Becker,et al.  Effect of Intravenous Nitroglycerin on Collateral Blood Flow and Infarct Size in the Conscious Dog , 1981, Circulation.

[5]  K. Schechtman,et al.  The Effects of Intravenous Nitroglycerin on Hemodynamics, Coronary Blood Flow and Morphologically and Enzymatically Estimated Infarct Size in Conscious Dogs , 1980, Circulation.

[6]  L. Kuhns.  REGIONAL ASSESSMENT OF MYOCARDIAL METABOLIC INTEGRITY VIVO BY POSITRON/EMISSION TOMOGRAPHY WITH “C-LABELED PALMITATE , 1980 .

[7]  K. Schechtman,et al.  The Influence of Location and Extent of Myocardial Infarction on Long-term Ventricular Dysrhythmia and Mortality , 1979, Circulation.

[8]  C. Conti,et al.  Coronary artery spasm: an important mechanism in the pathophysiology of ischemic heart disease. , 1979, Current problems in cardiology.

[9]  B. Zaret,et al.  Dissociation of effects of nitroglycerin on regional refractoriness and regional myocardial blood flow following acute coronary occlusion. , 1979, Cardiovascular research.

[10]  P. Thompson,et al.  Enzymatic Indices of Myocardial Necrosis: Influence on Short- and Long-Term Prognosis After Myocardial Infarction , 1979, Circulation.

[11]  R. Millard,et al.  Acute coronary occlusion in the pig: effect of nitroglycerin on regional myocardial blood flow. , 1978, The American journal of cardiology.

[12]  J. Williamson,et al.  Effects of Nifedipine on Myocardial Perfusion and Ischemic Injury in Dogs , 1978, British journal of clinical practice. Supplement.

[13]  R. Bache.  Effect of Nitroglycerin and Arterial Hypertension on Myocardial Blood Flow Following Acute Coronary Artery Occlusion in the Dog , 1978, Circulation.

[14]  P. B. Oliva,et al.  Arteriographic Evidence of Coronary Arterial Spasm in Acute Myocardial Infarction , 1977, Circulation.

[15]  S. Epstein,et al.  Comparison of nitroglycerin-, nitroprusside-, and phentolamine-induced changes in coronary collateral function in dogs. , 1977, The Journal of clinical investigation.

[16]  B. Groves.  Variant angina: an electrocardiographic and arteriographic spectrum produced by coronary artery spasm. , 1977, Current problems in cardiology.

[17]  R. Holland,et al.  Solid angle theory and the electrocardiogram: physiologic and quantitative interpretations. , 1977, Progress in cardiovascular diseases.

[18]  B. Sobel,et al.  Lack of protection of ischemic myocardium by verapamil in conscious dogs. , 1977, European journal of pharmacology.

[19]  S. Effert,et al.  Infarct Size Estimated from Serial Serum Creatine Phosphokinase in Relation to Left Ventricular Hemodynamics , 1977, Circulation.

[20]  H. Gold,et al.  Comparison Between the Effects of Nitroprusside and Nitroglycerin on Ischemic Injury during Acute Myocardial Infarction , 1976, Circulation.

[21]  B. Pitt,et al.  Nitroglycerin‐induced Severe Hypotension and Bradycardia in Patients with Acute Myocardial Infarction , 1976, Circulation.

[22]  L. Becker,et al.  Effects of intravenous nitroglycerin on left ventricular function and ST segment changes in acute myocardial infarction. , 1976, British heart journal.

[23]  J. Jarmakani,et al.  Effect of reperfusion on myocardial infarct, and the accuracy of estimating infarct size from serum creatine phosphokinase in the dog. , 1976, Cardiovascular research.

[24]  S. Epstein,et al.  Reduction in myocardial ischemia with nitroglycerin or nitroglycerin plus phenylephrine administered during acute myocardial infarction. , 1975, The New England journal of medicine.

[25]  B. Sobel,et al.  An Improved Basis for Enzymatic Estimation of Infarct Size , 1975, Circulation.

[26]  J. R. Cox,et al.  Relation between infarct size and ventricular arrhythmia. , 1975, British heart journal.

[27]  P. Ludbrook,et al.  Specificity of elevated serum MB creatine phosphokinase activity in the diagnosis of acute myocardial infarction. , 1975, The American journal of cardiology.

[28]  M. Mihalick,et al.  Nitroglycerin and premature ventricular complexes in myocardial infarction. , 1975, British heart journal.

[29]  J. Greenfield,et al.  Effects of nitroglycerin on transmural myocardial blood flow in the unanesthetized dog. , 1975, The Journal of clinical investigation.

[30]  B. Sobel,et al.  Rapid separation of plasma creatine kinase isoenzymes by batch adsorption on glass beads. , 1975, Clinical chemistry.

[31]  S. Epstein,et al.  Effects of nitroglycerin and nitroglycerin-methoxamine during acute myocardial ischemia in dogs with pre-existing multivessel coronary occlusive disease. , 1975, Circulation.

[32]  C. W. Small,et al.  Clinical measurement of myocardial infarct size. Modification of a method for the estimation of total creatine phosphokinase release after myocardial infarction. , 1975, Circulation.

[33]  S. Effert,et al.  Attempt to quantitate relation between cardiac function and infarct size in acute myocardial infarction. , 1974, British heart journal.

[34]  A. Kuroiwa,et al.  Effects of selective coronary hypotension and nitroglycerin or Bay a 1040 on the distribution of Rb86 clearance in the canine heart. , 1973, Cardiovascular research.

[35]  E. R. Smith,et al.  Coronary Artery Occlusion in the Conscious Dog: Effects of Alterations in Arterial Pressure Produced by Nitroglycerin, Hemorrhage, and Alpha‐Adrenergic Agonists on the Degree of Myocardial Ischemia , 1973, Circulation.

[36]  L. Becker,et al.  Effect of Ischemia and Antianginal Drugs on the Distribution of Radioactive Microspheres in the Canine Left Ventricle , 1971, Circulation research.

[37]  M. Winbury.  Redistribution of Left Ventricular Blood Flow Produced by Nitroglycerin: An Example of Integration of the Macro- and Microcirculation , 1971, Circulation research.

[38]  S. Rosalki.  An improved procedure for serum creatine phosphokinase determination. , 1967, The Journal of laboratory and clinical medicine.

[39]  D. Ayman,et al.  HARMFUL EFFECTS OF NITROGLYCERIN. With Special Reference to Coronary Thrombosis , 1932 .

[40]  W. Scott.  ON A CASE OF EXTRA-UTERINE FŒTATION. , 1862 .

[41]  E. Braunwald,et al.  Precordial electrocardiographic mapping. A technique to assess the efficacy of interventions designed to limit infarct size. , 1978, Circulation.

[42]  P. Mathes,et al.  Effect of nitroglycerin on total and regional coronary blood flow in the normal and ischaemic canine myocardium. , 1971, Cardiovascular research.

[43]  Winbury Mm.  Redistribution of left ventricular blood flow produced by nitroglycerin. An example of integration of the macro- and microcirculation. , 1971 .