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Coronary constriction in acute myocardial infarction: role of nitrates

D Hackett1, G Davies, A Maseri

  • 1Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, U.K.

European Heart Journal
|January 1, 1988
PubMed

Insights

Nitrates like isosorbide dinitrate can reopen blocked coronary arteries during acute myocardial infarction. Combining nitrates with thrombolytic therapy promotes stable blood flow and may improve patient outcomes.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Acute myocardial infarction involves coronary artery thrombosis and constriction.
  • Nitrates are vasodilators used in cardiovascular conditions.

Purpose of the Study:

  • To investigate coronary vasodilator responses to nitrates during acute myocardial infarction (AMI) and thrombolytic therapy.
  • To assess the efficacy of isosorbide dinitrate in achieving and maintaining coronary patency in AMI.

Main Methods:

  • Intracoronary administration of isosorbide dinitrate (2-4 mg) before, during, and after thrombolytic therapy.
  • Monitoring coronary artery patency, reopening, reocclusion, and ST-segment changes.
  • Evaluating vasodilator effects on infarct-related arteries versus adjacent normal branches.

Main Results:

  • Intracoronary isosorbide dinitrate did not induce recanalization of totally occluded arteries before thrombolysis.
  • Coronary reopening and reocclusion were frequent, both spontaneously and during thrombolysis.
  • Isosorbide dinitrate re-established patency in 50-86% of patients with incomplete or reoccluded arteries.
  • Post-thrombolysis, nitrates dilated infarct-related stenoses but not normal coronary branches.

Conclusions:

  • Coronary thrombosis and constriction are interacting factors in early AMI.
  • Combining high concentrations of nitrates with thrombolytic agents promotes stable coronary recanalization.
  • This combination therapy may be beneficial for patients with acute myocardial infarction.

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