title: Comparison of the time to onset of action on myocardial ischaemia following intravenous administration of isosorbide dinitrate and 5-isosorbide mononitrate in Chinese patients.
abstract: OBJECTIVE
  The onset of action of intravenous isosorbide dinitrate (CAS 87-33-2, ISDN) and intravenous 5-isosorbide mononitrate (CAS 16051-77-7, 5-ISMN) were compared by measurement of the indicators of perfusion to ischaemic myocardium.
  
  
  METHODS
  Twenty-five patients with coronary heart disease were randomly allocated to receive intravenous ISDN or 5-ISMN. The extent of myocardial ischaemia before infusion and at 3, 15 and 45 min after commencement of infusion was evaluated using 99mTc-MIBI myocardium tomography imaging and electrocardiograms.
  
  
  RESULTS
  The perfusion defects were significantly reduced or resolved in 11 patients (84.1%) receiving ISDN and 2 patients (15.38%) receiving 5-ISMN at 3 min. At 15 min the improvement was significantly greater in the ISDN group than in the 5-ISMN group. The improvements of 99mTc-MIBI myocardial uptake ratio and electrocardiograms were statistically significant in the ISDN group at 3 min and 15 min compared to pre-infusion. Although a significant improvement appeared at 15 min in the 5-ISMN group, it was significantly less than that observed in the ISDN group (p < 0.05). After 45 min, there were improvements in ischaemia in both groups with the difference compared to pre-infusion being significant, and there was no statistically significant difference between the ISDN and 5-ISMN group.
  
  
  CONCLUSIONS
  In patients with coronary heart disease with ischaemic episodes the onset of therapeutic activity was more rapid with intravenous ISDN compared to 5-ISMN. ISDN should be the preferred intravenous nitrate for acute ischaemic episodes where a rapid onset of therapeutic action is desired.
authors.affiliation: Department of Cardiovasology, Chang Zheng Hospital, Second Military Medical University, Shanghai, The People's Republic of China. zgwu@medmail.com.cn
authors.forename: Zong-gui
authors.initials: ZG
authors.lastname: Wu
authors.forename: Jian-nan
authors.initials: JN
authors.lastname: Li
authors.forename: Ming
authors.initials: M
authors.lastname: Fan
authors.forename: Yu-kun
authors.initials: YK
authors.lastname: Shang
authors.forename: Ya-wen
authors.initials: YW
authors.lastname: Zhang
authors.forename: Jin
authors.initials: J
authors.lastname: Bai
authors.forename: Ru
authors.initials: R
authors.lastname: Ding
authors.forename: Jing-Ming
authors.initials: JM
authors.lastname: Cheng
authors.forename: Chun
authors.initials: C
authors.lastname: Liang
mesh_terms: D000208:Acute Disease; D000368:Aged; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D007548:Isosorbide Dinitrate / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics* / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy*; D019275:Radiopharmaceuticals; D017256:Technetium Tc 99m Sestamibi; D014054:Tomography; D014055:Tomography, Emission-Computed; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000627:therapeutic use*
chemical_list: D019275:Radiopharmaceuticals; D014665:Vasodilator Agents; D017256:Technetium Tc 99m Sestamibi; D007548:Isosorbide Dinitrate; C030397:isosorbide-5-mononitrate