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 Yazdi3*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 Back to TOC