Key result
IV dipyridamole induces pacing ischemia at a ~13 bpm lower heart rate than nitroglycerin.
Why the study?
The comparative effects of intravenous dipyridamole and sublingual nitroglycerin on coronary hemodynamics and myocardial metabolism in patients with significant coronary obstruction were not well characterized.
Does intravenous dipyridamole compared to sublingual nitroglycerin affect coronary hemodynamics and tolerance to pacing-induced ischemia in patients with significant coronary obstruction?
Population
Patients with significant coronary obstruction
Comparison
Intravenous dipyridamole (20 mg) vs sublingual nitroglycerin (0.6 mg)
Design
Comparative physiological study
Authors
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Nitroglycerin may improve pacing tolerance in CAD; hypothesis-generating and should not yet change practice.
Does intravenous dipyridamole compared to sublingual nitroglycerin affect coronary hemodynamics and tolerance to pacing-induced ischemia in patients with significant coronary obstruction?
Absolute Event Rate: 136% vs 149%
p-value: p=<0.01
Nitroglycerin improves tolerance to pacing-induced ischemia compared to dipyridamole, likely due to systemic vasodilator effects rather than enhanced flow to ischemic myocardium.
Arrotti et al. (1980) studied Coronary artery disease. Intravenous dipyridamole vs. Sublingual nitroglycerin (0.6 mg) was evaluated on Heart rate at onset of chest pain and ischemic ECG changes (p=<0.01). Intravenous dipyridamole resulted in the onset of chest pain and ischemic ECG changes at a lower heart rate during atrial pacing compared to sublingual nitroglycerin (136 vs 149 beats/min, p<0.01).
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