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Comparison Between the Effects of Nitroprusside and Nitroglycerin on Ischemic Injury during Acute Myocardial Infarction

SUMMARY This clinical and experimental investigation was designed to delineate and compare the relative effects of sodium nitroprusside (NP) and nitroglycerin (TNG) on electrocardiographic ischemic injury following acute myocardial infarction in patients and following coronary artery occlusion in dogs. Accordingy, in ten patients with anterior acute myocardial infarction and ST-segment elevation stable for 60 min, the effects ofNP (average 95 4g/min i.v.) and TNG (average 0.48 mg sublingually) were studied. The hemodynamic actions of NP and TNG were directionally similar. However, NP increased average ST-segment elevation (ST) by 2.0 ± 0.2 mm, while TNG reduced ST by 1.4 ± 0.4 mm. In order to clarify this disparity, coronary artery occlusions were carried out in 14 open-chest dogs. During control, NP and TNG time periods, epicardial electrograms were recorded and regional myocardial blood flow (RMBF) determined by the microsphe te N side increased ST-egment elevation from 4.6 ± 0.6 to 5.7 ± 0.6 mV (P < 0.05) and reduced RMBF from 35± 3 to 27 ± 2 mI/uul/100 g (P < 0.01) in the ischemic zones. In contrs, TNG reced; STsegment elevation from 4.9 ± 0.7 to 3.0 ± 0.7 mV (P < 0.05), Wle increasing RMBF to 43 ± 4 ml/mi/100 g (P < 0.05) and the endo/ epicardial ratio from 0.57 ± 0.06 to 0.69 ± 0.07 (P < 0.01). Although TNG and NP exhibit similar hemodynamic effects, TNG reduced electrocardiographic ischemic injury, at least in part, by increasing perfusion of the ischemic areas and redistriutng it favorably, while NP increased electrocardiographic iscbemic injury, at least in part, by reducing perfusion. Therefore, TNG seems preferable to NP for reducing preload and afterload in ts during the early phase of acute myocardial infarction.