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Published on: April 4, 2022
Nicardipine or nitroglycerin in patients with failed percutaneous coronary angioplasty: effect on myocardial
Pierre A Casthely1, Tania Bunik, Pierre Alex Casthely
1Division of Cardiac Anaesthesia, St. Joseph's Regional Medical Center, Paterson, NJ 07503, USA.
Insights
Intracoronary nicardipine effectively improved diastolic function and myocardial flow in patients with failed percutaneous transluminal coronary angioplasty (PTCA) undergoing bypass surgery. This contrasts with nitroglycerin, which showed no significant benefit.
Area of Science:
- Cardiology
- Vascular Medicine
- Surgical Interventions
Background:
- Diastolic dysfunction is a significant complication in patients with failed percutaneous transluminal coronary angioplasty (PTCA).
- Effective management strategies are crucial for patients undergoing emergency coronary artery bypass grafting (CABG) after PTCA failure.
Purpose of the Study:
- To assess the efficacy of intracoronary vasodilators in improving diastolic function in patients with failed PTCA.
- To compare the effects of intracoronary nicardipine versus nitroglycerin on cardiac function and myocardial injury markers.
Main Methods:
- A clinical trial involving 32 patients with failed PTCA undergoing emergency CABG.
- Patients were randomized to receive either intracoronary nicardipine or nitroglycerin.
- Transesophageal echocardiography was utilized to evaluate diastolic function and myocardial velocity.
Main Results:
- Intracoronary nicardipine significantly improved mitral annular velocity (Ea) and left ventricular ejection fraction.
- Nitroglycerin did not show significant improvements in diastolic function or cardiac output.
- Nicardipine administration resulted in significantly lower troponin levels compared to nitroglycerin.
Conclusions:
- Intracoronary nicardipine is effective in improving diastolic function and myocardial flow velocity in patients with failed PTCA.
- Nicardipine offers a potential therapeutic benefit for patients undergoing emergency CABG after PTCA failure.
Objective:
To evaluate whether intracoronary vasodilators can improve diastolic function in 32 patients with failed percutaneous transluminal coronary angioplasty (PTCA).
Design:
Clinical trial.
Setting:
Single-institution, academic hospital.
Participants:
Failed PTCA patients undergoing emergency coronary artery bypass grafting surgery.
Interventions:
Patients were divided into 2 groups: group A received 0.1 mg of intracoronary nicardipine, and group B received 20 microg of intracoronary nitroglycerin. Both drugs were administrated via a coronary dilatation perfusion catheter inserted in the catheterization laboratory by the cardiologist. Subsequently, they were continuously infused via the side port of the introducer of the pulmonary artery catheter and titrated to keep systolic blood pressure at about two thirds of the control value. Transesophageal echocardiography (Power Vision/6000, 9-mm 5MHZ Probe; Toshiba, Elmsford, NY) was used in this study.
Measurements And Main Results:
Left ventricular ejection fraction, cardiac index, tissue Doppler imaging velocity of the left ventricle and mitral annulus, and troponin levels were measured before and after administration of the 2 vasodilators and after cardiopulmonary bypass. Diastolic dysfunction was found preoperatively in all the patients and responded only to intracoronary nicardipine. Ea of mitral annulus velocity significantly increased in group A patients from 7.5 +/- 0.02 to 11.8 +/- 0.01 (p < 0.005) and decreased in group B patients from 8.0 +/- 0.03 to 7.5 +/- 0.02 after nicardipine or nitroglycerin administration. Left ventricular ejection fraction and cardiac index increased significantly (p < 0.005) only after nicardipine administration. Troponin levels were significantly lower in group A than in group B patients (p < 0.005).
Conclusion:
Intracoronary nicardipine improves diastolic function and myocardial flow velocity in patients with failed PTCA undergoing emergency coronary artery bypass graft surgery.
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