Document Detail


A randomized clinical trial of intravenous nitroglycerin in patients with acute myocardial infarction: benefits of early treatment.
MedLine Citation:
PMID:  6421004     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
A prospective randomized clinical trial of intravenous nitroglycerin administered for 48 hours following acute infarction was undertaken to determine whether clinical improvement and/or preservation of ischemic myocardium could be demonstrated. One hundred four patients were randomized to receive either nitroglycerin or placebo infusion. Nitroglycerin infusion was titrated to lower mean arterial pressure 10% using non-invasive monitoring. Early nitroglycerin treatment, defined as treatment initiated less than 10 hours after symptom onset, resulted in a lower incidence of new congestive heart failure, myocardial infarct extension, and/or early death from pump failure (15%) compared to late nitroglycerin treatment (50%, p = 0.008) or early placebo treatment (48%, p = 0.01). Improvement in ejection fraction of greater than or equal to 10% was demonstrated in 7 of 20 (35%) early nitroglycerin treated patients compared to 6, 11 and 0% of patients in the three other subgroups, respectively (p = 0.004). Similarly, thallium-201 perfusion scintigrams showed a greater than 75% improvement in defect score in 23 (48%) patients receiving nitroglycerin within 10 hours compared to 14%, 33% and 0% respectively, in the remaining subgroups (p = 0.035). However, before routine administration of nitroglycerin can be recommended for all patients with acute infarction, larger clinical trials will be required.
Authors:
J T Flaherty; L C Becker; B H Bulkley; J L Weiss; G Gerstenblith; C H Kallman; B Pitt; M L Weisfeldt
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Publication Detail:
Type:  Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Zeitschrift für Kardiologie     Volume:  72 Suppl 3     ISSN:  0300-5860     ISO Abbreviation:  Z Kardiol     Publication Date:  1983  
Date Detail:
Created Date:  1984-03-21     Completed Date:  1984-03-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0360430     Medline TA:  Z Kardiol     Country:  GERMANY, WEST    
Other Details:
Languages:  eng     Pagination:  131-6     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Clinical Trials as Topic
Creatine Kinase / blood
Echocardiography
Electrocardiography
Humans
Infusions, Parenteral
Myocardial Contraction
Myocardial Infarction / drug therapy*,  physiopathology,  radionuclide imaging
Nitroglycerin / administration & dosage*
Random Allocation
Thallium / diagnostic use
Grant Support
ID/Acronym/Agency:
KO 4 HL 00019/HL/NHLBI NIH HHS; P 50 HL 17655/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
55-63-0/Nitroglycerin; 7440-28-0/Thallium; EC 2.7.3.2/Creatine Kinase

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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