Intracoronary nitroglycerin for ischemia reperfusion injury in elderly patients with acute coronary syndrome undergoing urgent endovascular revascularization // Intrakoronares Nitroglycerin bei Ischämie-Reperfusionsverletzung bei älteren Patienten

摘要

Background: Endovascular coronary revascularization is a golden standard of first aidin patients with acute coronary syndrome.Myocardial ischemia-reperfusion injury is amajor complication of coronary stenting, withthe elderly patients forming a high-risk group.Nitroglycerin is known to exhibit cardioprotective effects, however studies have displayedcontroversial results concerning effectivenessof the drug. Therefore, we aimed to investigatecardioprotective effect of nitroglycerin duringurgent coronary revascularization procedure inelderly patients and evaluated our results.Methods: Patients aged 60 years and olderwho underwent emergent coronary revascularization for acute coronary syndrome at our institution between 11/18 and 02/19, were managedand studied prospectively. All patients receivedstandard perioperative pharmacotherapy. Afteradding intracoronary nitroglycerin bolus to ouranesthetic procedure, we evaluated the STsegment elevation regression rate, incidence ofhemodynamic changes and rate of arrhythmias.Results: Thirty patients received standardperioperative pharmacotherapy (CG). Another30 patients additionally received nitroglycerinintracoronary prior to reperfusion (SG). In thenitroglycerin group a reduced frequency of noand slow-reflow phenomena (6,7 vs 26,7;p = 0,04), faster rate of ST segment elevationregression in the first hour post reperfusion(42.4 ± 17.6 vs 34.5 ± 9.7; p = 0.036), lowerrate of bradycardia (10 vs 33,3; p = 0,03)and hypotension (13,3 vs 40; p = 0,02) wereobserved. Arrhythmia incidence did not differbetween the groups (p = 0,365).Conclusions: Nitroglycerin is a widespreaddrug with cardioprotective capabilities. As ourstudy shows, intracoronary administration ofnitroglycerin reduces the incidence of no- andslow-reflow phenomena and hastens the rateof ST segment elevation regression 60 minutes’post reperfusion.