Comparative effects of oral molsidomine and nifedipine on methylergometrine-induced coronary artery spasm.
Twelve consecutive patients (10 men and 2 women, mean +/- standard deviation age 49 +/- 9 years) with chest pain, angiographically normal coronary arteries and coronary artery spasm documented by methylergometrine testing received a single oral dose of molsidomine (4 mg) or nifedipine (10 mg) in a randomized, double-blind, crossover fashion at a 24-hour interval. Coronary artery spasm was documented during coronary angiography in 6 patients (left anterior descending artery, 3; right coronary artery, 2; left circumflex, 1). In the remaining 6 patients, coronary artery spasm was documented by a positive methylergometrine test performed at the bedside, which provoked ST-segment elevation in the inferior (n = 3), anterior (n = 1) or lateral (n = 2) leads. Ninety minutes after administration of the study medication, methylergometrine testing was performed at the bedside, using incremental doses of up to 0.4 mg of methylergometrine. After molsidomine, 10 patients (83%) had a negative and 2 had a positive test; after nifedipine, 9 patients (75%) had a negative and 3 a positive test. Only 1 patient had a methylergometrine test that remained positive after either molsidomine or nifedipine. Therefore, molsidomine appears as effective as nifedipine in suppressing methylergometrine-induced coronary artery spasm in patients with variant angina. In addition, patients not responding to 1 of the study medications may respond to the other.
Danchin
N
N
Département des Maladies Cardiovasculaires, Chu Nancy-Brabois, Vandoeuvre-lès-Nancy, France.
Juillière
Y
Y
Anconina
J
J
Perrin
O
O
Selton-Suty
C
C
Cherrier
F
F
D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000139:chemically induced / Q000188:drug therapy*; D003331:Coronary Vessels / Q000187:drug effects; D004311:Double-Blind Method; D004874:Ergonovine / Q000031:analogs & derivatives; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008981:Molsidomine / Q000627:therapeutic use*; D009543:Nifedipine / Q000627:therapeutic use*
D008981:Molsidomine; D009543:Nifedipine; D004874:Ergonovine