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[Treatment of symptomatic and asymptomatic myocardial ischemia using 120 mg delayed-action ISDN]
G Reiniger1, G Lehmann, A Beyerle
1Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München.
Insights
Sustained-release isosorbide dinitrate significantly reduced myocardial ischemia episodes in coronary artery disease patients. This treatment effectively decreased both symptomatic and asymptomatic ischemic events during daily activities.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Myocardial ischemia in coronary artery disease often occurs asymptomatically during daily activities.
- The benefits of treating asymptomatic ischemia are not well-established, unlike symptomatic angina.
- Reliable data on medical treatment's impact on ischemic episodes is limited.
Purpose of the Study:
- To investigate the effect of sustained-release isosorbide dinitrate on transient myocardial ischemia.
- To analyze changes in frequency, duration, extent, and circadian variation of ischemic episodes.
- To differentiate treatment effects from spontaneous day-to-day fluctuations in ischemia.
Main Methods:
- Double-blind, randomized, placebo-controlled study.
- 25 patients with documented coronary artery disease.
- Two 48-hour Holter monitoring periods with and without 120 mg sustained-release isosorbide dinitrate.
Main Results:
- A significant reduction in ischemic episodes from 277 (placebo) to 119 (-57%) during isosorbide dinitrate treatment (p < 0.05).
- Both symptomatic (54% decrease) and asymptomatic (58% decrease) episodes were comparably reduced.
- The treatment demonstrated effectiveness in mitigating transient myocardial ischemia during everyday activities.
Conclusions:
- Sustained-release isosorbide dinitrate effectively reduces the frequency of transient myocardial ischemia in patients with coronary artery disease.
- The drug is beneficial for both symptomatic and asymptomatic ischemic episodes.
- This study provides evidence supporting the use of isosorbide dinitrate in managing myocardial ischemia.
Abstract:
Most episodes of myocardial ischemia in patients with coronary artery disease are incurred asymptomatically during everyday physical activities. While the necessity for medical treatment of angina pectoris is clearly established, the indication for treatment of asymptomatic ischemia is based on prevention of structural myocardial damage or malignant arrhythmias and on the implication of improvement in prognosis. In this regard, however, no reliable data is available. Additionally, only relatively few controlled studies have been carried out to investigate the influence of medical treatment on the ischemic episodes. Moreover, on assessment of treatment with Holter monitoring, as opposed to standardized ergometric testing, the substantial spontaneous variability of the frequency of ischemic episodes from day to day must be taken into consideration. Accordingly, in 25 patients with documented coronary artery disease, using a double-blind, randomized, placebo-controlled protocol with two periods of 48 hours of Holter monitoring each, we analyzed the effects of 120 mg isosorbide dinitrate in sustained-release form on the frequency, duration and extent as well as the circadian variation of transient myocardial ischemia during everyday physical activities and differentiated these from the spontaneous day-to-day fluctuations. During the placebo phase, 277 episodes with ST-segment depression greater than 1 mm were detected, 81% of which were asymptomatic. During treatment with 120 mg isosorbide dinitrate in sustained-release form, the number of episodes was reduced significantly (p less than 0.05) to 119 (-57%) where the decrease in symptomatic and asymptomatic episodes of 54% and 58%, respectively, was comparable (Figure 1).(ABSTRACT TRUNCATED AT 250 WORDS)