Prophylactic nitroglycerin did not reduce myocardial ischemia during accelerated recovery management of coronary artery bypass graft surgery patients

Abstract

Objective: To evaluate the use of a high dose of nitroglycerin (NTG) for prophylaxis against myocardial ischemia and infarction in patients undergoing coronary artery bypass graft (CABG) surgery with accelerated recovery. Design: Prospective, double-blind, placebo-controlled randomized study. Setting: A university-based medical center. Participants: Forty adult patients presenting for elective CABG surgery. Interventions: Forty patients were divided into 2 blinded study groups. Twenty patients received 2 μg/kg/min of NTG starting before induction of anesthesia and continuing for 6 hours after extubation in the intensive care unit. The placebo group (n = 20) received normal saline during this same interval. Measurements and Main Results: Hemodynamics, incidence and severity of myocardial ischemia, and myocardial infarction rates were determined. There were no differences in hemodynamic parameters between groups. The incidence of ischemia was approximately 35 in each group. Myocardial infarction (as determined by elevated creatine kinase—MB fraction, troponin I, and electrocardiogram criteria) was 10% in the placebo group and 5 in the NTG group (p = 0.234). Conclusions: This study shows a high incidence of myocardial ischemia and infarction in patients presenting for CABG surgery with an accelerated recovery management scheme. NTG was well tolerated clinically; however, it was not found to be protective against myocardial ischemia or infarction in this setting. Copyright © 2000 by W.B. Saunders Company