Buccal nitroglycerin decreases ischemic pain during coronary angioplasty: a double-blind, randomized, placebo-controlled study.
Nitroglycerin (NTG) has the potential to reduce myocardial ischemia during percutaneous transluminal coronary angioplasty (PTCA). Buccal administration of NTG offers practical advantages compared to intravenous or intracoronary administration. In a double-blind, randomized, placebo-controlled study, 100 patients were given 5 mg of buccal NTG or placebo during PTCA. A scoring system for ischemic pain during balloon inflation was defined as pain intensity (0 to 5) multiplied by duration of pain after balloon deflation (1 = 0 to 30 seconds, 2 = 30 to 60 seconds, 3 = 60 to 120 seconds, 4 = greater than 120 seconds but subsiding, and 5 = until next inflation). Fourteen patients were excluded: 12 for vagal reaction (eight NTG and four placebo; p greater than 0.05) requiring atropine, making buccal absorption unreliable, and two for inability to dilate. Eighteen patients (nine NTG and nine placebo) had no pain during balloon inflation. Sixty-eight patients (32 NTG and 36 placebo) had ischemic pain with a pain score (mean +/- SD) of 4.8 +/- 3.8 for the NTG group versus 7.1 +/- 4.8 for the placebo group (p = 0.03). We conclude that buccal NTG significantly decreases myocardial ischemia during PTCA.
Johansson
S R
SR
Department of Cardiology, University of Göteborg, Sahlgrenska Hospital, Sweden.
Ekström
L
L
Emanuelsson
H
H
D000278:Administration, Buccal; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003327:Coronary Disease / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D004311:Double-Blind Method; D006801:Humans; D007432:Intraoperative Period; D005996:Nitroglycerin / Q000008:administration & dosage* / Q000627:therapeutic use; D010146:Pain; D010149:Postoperative Pain; D010166:Palliative Care; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence
D005996:Nitroglycerin