Key result
Nitroglycerin outperforms diltiazem for preventing post-CABG radial artery spasm, cutting pacing needs by ~54% and minimizing crossovers.
Why the study?
A clinical comparison of nitroglycerin versus diltiazem for prevention of radial artery spasm after coronary bypass grafting had not been previously performed.
Does nitroglycerin improve tolerability and clinical outcomes compared to diltiazem for the prevention of radial artery conduit spasm in patients undergoing CABG?
RCT (n=161)
prospectively randomized
Does nitroglycerin improve tolerability and clinical outcomes compared to diltiazem for the prevention of radial artery conduit spasm in patients undergoing CABG?
Absolute Event Rate: 0% vs 6.5%
p-value: p=0.05
Nitroglycerin is a safe, effective, better tolerated, and less costly alternative to diltiazem for preventing radial artery spasm after coronary bypass grafting.
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Nitroglycerin should replace diltiazem for radial artery spasm prevention after CABG due to superior tolerability; strengthens RCT evidence for its first-line use.
Shapira et al. (2000) conducted an RCT in coronary bypass conduit spasm (n=161). Nitroglycerin vs. Diltiazem was evaluated on Crossovers because of low cardiac output, complete heart block, or sinus bradycardia (p=0.05). Nitroglycerin was preferable to diltiazem for preventing radial artery spasm after CABG, resulting in fewer crossovers due to adverse events (0% vs 6.5%, p=0.05) and less pacing (13% vs 28%, p=0.01).
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