Infusion of nifedipine after coronary artery bypass grafting decreases the incidence of early postoperative myocardial ischemia.
We performed a randomized study on patients undergoing elective coronary bypass grafting to examine whether postoperative infusion of nifedipine (n = 25) could reduce the incidence of isolated transient myocardial ischemia, myocardial infarction, or both. The control group (n = 25) received nitroglycerin. Hemodynamic and Holter monitoring and serial assessment of enzymatic and electrocardiographic changes were performed for all patients. Both groups showed comparable preoperative and operative data. The incidence of myocardial infarction was significantly lower in the nifedipine group (n = 1) as compared with the control group (n = 4), whereas the number of patients with isolated transient myocardial ischemia was similar in both groups (nifedipine, 3; control, 4). At the time of peak activity, levels of creatine kinase (350 +/- 129 versus 511 +/- 287 IU/mL), creatine kinase-MB (8.4 +/- 5.4 versus 17.1 +/- 11.0 IU/mL), and glutamate-oxaloacetate-transaminase (30.4 +/- 4.4 versus 41.0 +/- 7.9 IU/mL) were markedly lower in the nifedipine group (p less than 0.05). We conclude that infusion of nifedipine after elective coronary artery bypass grafting effectively decreases the incidence of myocardial infarction and the extent of myocardial necrosis during the early postoperative period.
Seitelberger
R
R
II. Department of Surgery, University of Vienna, Austria.
Zwölfer
W
W
Binder
T M
TM
Huber
S
S
Peschl
F
F
Spatt
J
J
Schwarzacher
S
S
Holzinger
C
C
Coraim
F
F
Weber
H
H
D001794:Blood Pressure / Q000187:drug effects; D002302:Cardiac Output / Q000187:drug effects; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D003327:Coronary Disease / Q000517:prevention & control*; D003402:Creatine Kinase / Q000097:blood; D004562:Electrocardiography / Q000187:drug effects; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D015994:Incidence; D007262:Infusions, Intravenous; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*; D009543:Nifedipine / Q000008:administration & dosage / Q000627:therapeutic use*; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use; D011182:Postoperative Care; D011897:Random Allocation
D007527:Isoenzymes; D003402:Creatine Kinase; D005996:Nitroglycerin; D009543:Nifedipine