Circulation, Vol 54, 766-773, Copyright © 1976 by American Heart Association
M Chiariello, HK Gold, RC Leinbach, MA Davis and PR Maroko
This clinical and experimental investigation was designed to delineate and
compare the relative effects of sodium nitroprusside (NP) and nitroglycerin
(TNG) on electrocardiographic ischemic injury following acute myocardial
infarction in patients and following coronary artery occlusion in dogs.
Accordingly, in ten patients with anterior acute myocardial infarction and
ST-segment elevation stable for 60 min, the effects of NP (average 95
mug/min i.v.) and TNG (average 0.48 mg sublingually) were studied. The
hemodynamic actions of NP and TNG were directionally similar. However, NP
increased average ST-segment elevation (ST) by 2.0 +/- 0.2 mm, while TNG
reduced ST by 1.4 +/- 0.4 mm. In order to clarify this disparity, coronary
artery occlusions were carried out in 14 open-chest dogs. During control,
NP and TNG time periods, epicardial electrograms were recorded and regional
myocardial blood flow (RMBF) determined by the microsphere technique.
Nitropruside increased ST-segment elevation from 4.6 +/- 0.6 to 5.7 +/- 0.6
mV (P less than 0.05) and reduced RMBF from 35 +/- 3 to 27 +/- 2 ml/min/100
g (P less than 0.01) in the ischemic zones. In contrast, TNG reduced ST-
segment elevation from 4.9 +/- 0.7 to 3.0 +/- 0.7 mV (P less than 0.05),
while increasing RMBF TO 43 +/0 4 ml/min/100 G (P less than 0.05) and the
endo/epicardial ratio from 0.57 +/- 0.06 to 0.69 +/- 0.07 (P less than
0.01). Although TNG and NP exhibit similar hemodynamic effects, TNG reduced
electrocardiographic ischemic injury, at least in part, by increasing
perfusion of the ischemic areas and redistributing it favorably, while NP
increased electrocardiographic ischemic injury, at least in part, by
reducing perfusion. Therefore, TNG seems preferable to NP for reducing
preload and afterload in patients during the early phase of acute
myocardial infarction.
ARTICLES
Comparison between the effects of nitroprusside and nitroglycerin on ischemic injury during acute myocardial infarction
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