Effect of Intracoronary Sodium Nitroprusside Before Percutaneous Coronary Intervention on Periprocedural Myonecrosis : A Prospective Randomized Study

Javad Ramezani¹, Mohammad Tayyebi², Ali Eshraghi¹ and Majid Jalal Yazdi^3*

¹Assistant Professor of Interventional Cardiology, Atherosclerosis Prevention Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. ²Assistant Professor of  Interventional Electrophysiology, Atherosclerosis Prevention Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. ³Assistant Professor of Cardiology, Atherosclerosis Prevention Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Corresponding Author Email: jalalyazdim@mums.ac.ir

Abstract: Aim of this study is to evaluate the effect of pre PCI administration of  intracoronary nitroprusside on post procedural myonecrosis. Myonecrosis is a prognostically important complication of PCI. Nitric oxide is a potent vasodilator in the resistance arteriolar circulation, and plays a significant role in the control of coronary blood flow through the microcirculation. nitroprussideis a direct donor of nitric oxide. A total of 62 patients were randomized into the NTP (n= 31) or control (n= 31) group. Patients who were scheduled for non-urgent PCI in de novo native coronary arteries were eligible. All patients were pretreated with statin, aspirin and clopidogrel. Myonecrosis was measured by CK-MB elevation 24 h after PCI. The NTP group received intracoronary NTP befor PCI, whereas the control group did not. Results : All patients in NPT group received NTP for prevention of myonecrosis at a dose of at least 50 µg given intrcoronary through guiding catheter.   22 patients  received 50µg,7 patients  received 100µg and 3patients  received 150µg. The baseline CPK-MB concentration was 16±4.89 and 16.55±6.18 in the control and NTP groups, respectively (P=0.70). The mean increase of  CPK-MB concentration 24h after PCI was 20±26.64 and 10.13±14.35 in the control and NTP groups, respectively (P=0.06). Mean systolic BP before injection of NTP was 144.58±21.51mmHg and after injection of NPT was 121±21.51mm Hg. Bolus administration of NTP through the guiding catheter is associated with reduction in the occurrence of myonecrosis following non-urgent PCI in patients pretreated with dual antiplatelet agents and statins.

Keywords: Sodium Nitroprusside; Percutaneous Coronary Intervention; Periprocedural Myonecrosis

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