Cardiovascular medicine
Randomised comparison of the effects of nicardipine and esmolol
on coronary artery wall stress: implications for the risk of plaque
rupture
M J A Williams, C J S Low, G T Wilkins, R A H Stewart
Department of
Medicine, University of Otago, 201 Great King Street, Dunedin, New
Zealand
Correspondence to: Dr Williams michael.williams{at}stonebow.otago.ac.nz
Accepted 28 June 2000
OBJECTIVE
To determine whether the
blocker esmolol reduces coronary artery wall stress more than the
short acting dihydropyridine calcium antagonist nicardipine.
DESIGNRandomised double blind
placebo controlled trial.
SETTINGTertiary cardiology centre.
PATIENTSPatients with coronary
artery disease.
INTERVENTIONS20 patients were
randomised double blind to an infusion of nicardipine (n = 10) or
esmolol (n = 10) titrated to reduce systolic blood pressure by
20 mm Hg.
MAIN OUTCOME MEASURESPeak systolic
wall circumferential stress.
RESULTSEsmolol reduced peak coronary
stress by a mean of 0.17 × 106 dyn/cm2
(95% confidence interval (CI) 0.14 to
0.21 × 106 dyn/cm2) compared with a
reduction of 0.07 × 106 dyn/cm2 (95% CI
0.05 to 0.10 × 106 dyn/cm2) after
nicardipine. Peak systolic radius was reduced by 0.04 mm (95% CI 0.03 to 0.06 mm) after esmolol compared with an increase of 0.08 mm (95%
CI 0.05 to 0.10 mm) after nicardipine. Heart rate increased by 11.5 beats/min (95% CI 6.9 to 16.2 beats/min) after nicardipine and
decreased by 5.3 beats/min (95% CI 1.9 to 8.6 beats/min) after esmolol.
CONCLUSIONSIntravenous esmolol is
more effective than nicardipine at reducing circumferential coronary
artery wall stress.
Keywords:
blockers;
calcium channel antagonists;
mechanics;
coronary disease
© 2000 by Heart
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