Heart 1998;80:365-369 ( October )
Nitrate induced coronary vasodilatation: differential effects of sublingual application by capsule or spray
Division of Cardiology, University Hospital,
3010 Berne, Switzerland
Correspondence to: Dr Seiler.
Accepted for publication 9 February 1998
Background
Sublingual nitroglycerin
(glyceryltrinitrate, GTN) capsules or isosorbide dinitrate (ISDN) spray
are routinely used to treat anginal attacks and to vasodilate maximally
the epicardial coronary arteries during coronary angiography.
ObjectiveTo compare the coronary vasodilatory
effects of GTN capsules and ISDN spray with those induced by
intracoronary GTN using quantitative coronary angiography.
Design96 patients (79 men and 17 women; median
age 59 years) were randomised to four groups to receive either a
sublingual capsule containing 0.8 mg GTN or two puffs of spray
delivering 0.8 mg ISDN, followed or preceded by an intracoronary
bolus of 0.2 mg GTN used as reference for maximal vasodilatation.
ResultsThere was a significant increase in the
mean diameter of coronary arteries in angiographically normal segments
in patients who received either intracoronary GTN (groups 1 and 2) or
ISDN spray (group 4) as a first application (group 1, 0.46 mm, +17%, (baseline vessel diameter 100%), p < 0.001; group 2, 0.45 mm, +13%, p < 0.001; group 4, 0.47 mm, +13%, p < 0.05). Patients
who received a sublingual GTN capsule as the first application mode (group 3) had no significant change in epicardial vessel diameter (0.10 mm, +5%, p = 0.3).
ConclusionsSublingual ISDN spray may be more
efficacious than sublingual GTN capsules in certain patients with
anginal attacks. ISDN spray should be preferred over capsules in
coronary angiographic procedures.
© 1998 by Heart
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