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[Hemodynamic response to intracoronary injection of a vasodilator during coronary angiography. A randomized
1Service de cardiologie diagnostique et interventionnelle, centre chirurgical Marie-Lannelongue, Le Plessis-Robinson.
Insights
Linsidomine offers a safer alternative to nitroglycerin during coronary angiography, causing less blood pressure drop. This study compared linsidomine and nitroglycerin for vasodilation, finding linsidomine significantly reduced hypotensive effects.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Intracoronary vasodilator agents are routinely used during coronary angiography and angioplasty.
- Nitroglycerin is the standard agent but can cause significant dose-dependent hypotension.
Purpose of the Study:
- To compare the vasodilatory effects and hemodynamic impact of linsidomine versus nitroglycerin.
- To evaluate linsidomine as a potential alternative to nitroglycerin in coronary procedures.
Main Methods:
- A randomized open trial involving 80 patients undergoing coronary angiography.
- Patients received either nitroglycerin (0.15 mg) or linsidomine (0.8 mg) intracoronary.
- Aortic pressure and heart rate were monitored, and vasodilation quality was assessed by an experienced angiographist.
Main Results:
- Linsidomine caused only a moderate fall in systolic pressure, while nitroglycerin led to significant drops in all pressure parameters.
- Maximal systolic pressure difference was -4 +/- 7.3 mmHg for linsidomine vs. -11.3 +/- 9.2 mmHg for nitroglycerin (p < 0.001).
- Heart rate remained stable in both groups, with no significant adverse clinical effects reported.
Conclusions:
- Linsidomine demonstrates a more favorable hemodynamic profile compared to nitroglycerin during coronary angiography.
- Linsidomine is a viable and potentially safer alternative to nitroglycerin, offering effective vasodilation with reduced hypotensive risk.
Abstract:
Intracoronary injection of a vasodilator agent in an almost systematic practice during coronary angiography or angioplasty because of the dynamic information that it provides concerning the stenosis, the artery in the unstenosed segment and spastic phenomena. Nitroglycerin is the reference drug with, however, a significant dose-dependent hypotensive effect. The aim of this randomised open trial was to compare the effects of Linsidomine, the active metabolite of molsidomide with the reference product. Eighty patients aged 59.2 +/- 10.4 years received either 0.15 mg of nitroglycerin or 0.8 mg of linsidomine during coronary angiography. Aortic pressure and heart rate were monitored continuously over 3 minutes; at the 3rd minute and injection of contrast was performed under fluoroscopic control under the same conditions as the basal injection for an experienced coronary angiographist to judge semi-quantitatively the quality of vasodilation at the site of stenosis and in the whole artery. In the linsidomine group, the only significant change was a moderate fall in systolic pressure from the 1st to the 3rd minute. In the nitroglycerin group, all pressure parameters fell from the 30th second. The heart rate remained stable in both groups. The maximal pressure differences were significantly different in the two groups: -4 +/- 7.3 mmHg versus -11.3 +/- 9.2 mmHg (linsidomine versus nitroglycerin), p less than 0.001 for systolic pressure; -0.1 +/- 5 mmHg versus -3 +/- 5.4 mmHg respectively for diastolic pressure (p less than 0.05); and -1 +/- 6 mmHg versus -5.3 +/- 6.4 mmHg (p less than 0.01) for mean pressure. These pressure changes were not associated with any detectable untoward clinical effect in either group of patients.(ABSTRACT TRUNCATED AT 250 WORDS)