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Intravenous nitroglycerin reduces ischaemia in unstable angina pectoris: a double‐blind placebo‐controlled study
Author(s) -
Karl-Erik Karlberg,
Tom Saldeen,
Rolf Wallin,
Peter Henriksson,
O. Nyquist,
Christer Sylvén
Publication year - 1998
Publication title -
journal of internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.625
H-Index - 160
eISSN - 1365-2796
pISSN - 0954-6820
DOI - 10.1046/j.1365-2796.1998.00253.x
Subject(s) - medicine , placebo , angina , chest pain , anesthesia , randomization , unstable angina , placebo controlled study , myocardial infarction , randomized controlled trial , double blind , cardiology , alternative medicine , pathology
Karlberg K‐E, Saldeen T, Wallin R, Henriksson P, Nyquist O, Sylvén C (Huddinge Hospital, Huddinge; University of Uppsala, Uppsala; and Södertälje; Sweden). Intravenous nitroglycerin reduces ischaemia in unstable angina pectoris: a double‐blind placebo‐controlled study. J Intern Med 1998; 243 : 25–31 Objectives To study whether intravenous nitroglycerin (NTG) reduces the incidence of ischaemic events and leucocyte activation, as well as inhibiting platelet aggregation in patients with unstable angina pectoris. Design Randomized double‐blind placebo‐controlled study. Subjects One hundred and sixty‐two patients with a history and electrocardiographic changes suggesting unstable angina pectoris. Interventions A 48‐hour titrated intravenous infusion of NTG or placebo. Results Of the 162 randomized patients, 19 were excluded because of an acute myocardial infarction on randomization (11 patients) or proven presence of a non‐ischaemic cause of the pain (6 patients). Other causes (2 patients). No differences in the clinical findings were detected between the groups on randomization. In the comparison of NTG and placebo, fewer patients in the former group had more than two new attacks of chest pain lasting for <20 min or one new attack of chest pain lasting >20 min, despite sublingual NTG (13/25, P < 0.03). In addition, the attacks of pain lasting >20 min in the NTG group were delayed compared to those in the placebo group ( P < 0.05), suggesting a beneficial effect on these more servere episodes. Fewer patients in the NTG group required more than two sublingual NTG tablets ( P < 0.005). NTG also reduced the rate‐pressure product ( P < 0.05), compared to placebo after 2 h but not after 24 h. Compared to baseline, platelet aggregation was inhibited in the patients who had received an NTG infusion for 2 h ( P < 0.05). In both groups, leucocytes were activated at baseline, but remained unchanged thereafter. Conclusions Intravenous NTG seems to reduce myocardial ischaemia in patients with unstable angina pectoris more than the placebo.