Nitroglycerin is preferable to diltiazem for prevention of coronary bypass conduit spasm

摘要: Abstract Background . Diltiazem is widely used to prevent radial artery spasm after coronary bypass grafting (CABG). However, recent in vitro and vivo studies have shown that nitroglycerin a superior conduit vasodilator compared diltiazem. A clinical comparison of these agents patients undergoing CABG has not been previously performed. Methods One hundred sixty-one consecutive isolated with the were prospectively randomized 24-hour intravenous infusion or diltiazem followed by 6-month treatment daily dose isosorbide mononitrate (n = 84) CD 77). Analyses performed on "intention-to-treat" basis. Results Crossovers because low cardiac output, complete heart block, sinus bradycardia occurred 5 group none ( p 0.05). Operative mortality (nitroglycerin, 1.2% versus diltiazem, 1.3%), major morbidity (14% 16%), perioperative myocardial infarction (1.2% 0%), peak serum creatinine phosphokinase MB fraction levels (27 21 U), intensive care unit stay (34 ± 19 38 30 hours) total hospital length (4.7 1.4 4.7 1.3 days) similar significant for all). Cardiac pacing was required more often (28% 13%, 0.01). Follow-up longer than 2 months available 145 (90%). 1.2%; (6%, 5%), reintervention (8% 6%) rates average angina class (1.3 0.7 1.1 0.4) Thallium stress test obtained 117 showed abnormal perfusion territory only 4 (3%), each significant). Treatment costly ($16,340 $1,096). Conclusions Nitroglycerin preferable prevention spasm. safe, effective, better tolerated, less therefore, should be agent choice.