Cardioprotective effect of nitroglycerin in emergency percutaneous endovascular myocardial revascularization in elderly patients with acute coronary syndrome

O.S. Furkalo, O.A. Loskutov, D.O. Dziuba, A.O. Maksakov, A.V. Khokhlov, B.M. Todurov


Background. In 2018, in the United States, coronary heart disease caused deaths of 43.8 % of patients and took the leading role in the structure of mortality due to cardiovascular pathology. Endovascular revascularization of the coronary arteries is considered to be the gold standard of emergency care in acute coronary syndrome. A significant complication of even a technically correct procedure can be ischemic and reperfusion injury of the myocardium. One of the groups of drugs for cardioprotection is nitrates, the most commonly used of which is nitroglycerin. There is no unanimous opinion about the feasibility and efficacy of using this drug for cardioprotection because of its predominant impact on the venous vascular bed and the development of tolerance in case of continuous administration. Objective: to investigate the cardioprotective effect of nitroglycerin in elderly patients with acute coronary syndrome during endovascular myocardial revascularization. Materials and methods. We examined 60 patients aged 60 years and older (mean age 67.05 ± 5.19 years) diagnosed with acute coronary syndrome, who underwent emergency endovascular myocardial revascularization at the State Institution “Heart Institute” of the Ministry of Health of Ukraine from November 5, 2018 to February 2, 2019. All patients were divided into 2 groups: 30 patients were included in group I, 30 — in group II. All patients in group I received a bolus of 200 mg nitroglycerin in the infarct-related artery before recanalization, and people in group II took standard drug therapy. The frequency of no- and slow-reflow phenomena, hemodynamic changes after and during reperfusion, the regression of the ST segment in dynamics, the frequency of rhythm disturbances, and significant intrahospital complications were eva­luated in both groups. Results. Patients aged 60 years and older with acute coronary syndrome who were injected with intracoronary nitroglycerin (GrI) had a significantly lower (2.5-fold) incidence of no-reflow phenomenon (6.7 and 16.7 %, respectively, in GrI and GrII, p < 0.05) compared to controls and twice the incidence of reperfusion bradycardia with hypotension (10 % in GrI versus 20 % in GrII, p < 0.05). In the postoperative period, there was a significant difference (4-fold) in the incidence of chest pain (6.7 % in GrI versus 26.7 % in GrII, p < 0.05) and in the incidence (2.5-fold) of cardiac arrhythmias (13.3 and 33.3 % in the first and second groups, respectively, p < 0.05). The difference in the regression value of the ST segment in the first hour after intervention was also significant (by 67.5 % in GrI versus 53.8 % in GrII, p = 0.159). Instead, the difference between the regression values of the ST segment in the first 24 hours was insignificant (p = 0.68) — 78.9 and 76.5 %, respectively, in the first and second groups. The difference in the frequency of the slow-reflow phenomenon and severe postoperative complications was also statistically insignificant. Conclusions. Intracoronary administration of nitroglycerin at a dose of 200 mg during recanalization of the infarct-related vessel resulted in a decrease of hemodynamic manifestations of reperfusion syndrome and a reduction in the incidence of the no-reflow phenomenon.


acute coronary syndrome; percutaneous endovascular coronary revascularization; no-reflow phenomenon


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