Author + information
- Received November 19, 1993
- Revision received February 18, 1994
- Accepted February 28, 1994
- Published online July 1, 1994.
- John J. Mahmarian, MDa,∗,
- Nancy L. Fenimore, RN, BSNa,
- Gary F. Marks, BSa,
- Marilyn J. Francis, RNa,
- Hugo Morales-Ballejo, MD∗,
- Mario S. Verani, MD, FACCa and
- Craig M. Pratt, MD, FACCa
- ↵∗Address for correspondence: Dr. John J. Mahmarian, 6550 Fannin, SM-1246, Houston, Texas 77030.
Objectives. This study prospectively evaluated whether transdermal nitroglycerin patches could limit the extent of exercise-induced left ventricular ischemia as assessed by quantitative thallium-201 tomography.
Background. Although antianginal medications are effective at reducing chest pain symptoms in patients with coronary artery disease, there is limited evidence that these agents can also reduce myocardial ischemia.
Methods. This was a randomized, double-blind, parallel, placebo-controlled trial evaluating nitroglycerin patch therapy in patients in stable condition with angiographic coronary artery disease and no previous myocardial infarction. All patients were weaned from antianginal agents and had a baseline symptom-limited treadmill test followed by thallium-201 tomography. Forty patients with perfusion defects involving ≥5% of the left ventricle were randomized to receive either intermittent (12 h on/off) active nitroglycerin patch therapy (0.4 mg/h) or placebo. Exercise tomography was repeated a mean (±SD) of 6.1 ± 1.8 days after randomization.
Results. Patients randomized to receive active patch therapy had a significant reduction in their total perfusion defect size (−8.9 ± 11.1%) compared with placebo-treated patients (−1.8 ± 6.1%, p = 0.04), which was most apparent in those with the largest (≥20%) baseline perfusion defects (−11.4 ± 13.4% vs. 1.0 ± 3.6%, respectively, p < 0.02). Furthermore, 7 (33%) of 21 patients receiving active therapy had a ≥10% decrease in their perfusion defects compared with only 1 (5%) of 19 patients randomiztd to receive placebo (p = 0.002). Nitrate therapy did not significantly reduce heart rate, blood pressure or double product, indicating benefit through enhancement of coronary blood flow.
Conclusions. Short-term, intermittent nitroglycerin patch therapy significantly reduces myocardial ischemia, particularly in patients with large ischemic perfusion defects. Thallium-201 tomography can be used to assess sequential changes in the extent of exercise-induced left ventricular ischemia.
☆ This study was presented in part at the 42nd Annual Scientific Session of the American College of Cardiology, Anaheim, California, March 1993. Computational assistance was provided by the CLINFO Project, funded by the Division of Research Resources of the National Institutes of Health, Bethesda, Maryland, under Grant RR-00350. This study was supported by a grant from Schering-Plough Research Institute, Kenilworth, New Jersey.
- Received November 19, 1993.
- Revision received February 18, 1994.
- Accepted February 28, 1994.