RANDOMIZED TRIAL OF INTRAVENOUS DILTIAZEM OR NITROGLYCERIN IN THE TREATMENT OF UNSTABLE ANGINA-PECTORIS

Prognosis of unstable angina pectoris is related to admission EKG chan ges and prompt symptom control. The aim of this study was to compare t he clinical effects of intravenous diltiazem (DTZ) or nitroglycerin (N TG) in patients with unstable angina pectoris. We studied 43 patients admitted to the hospital with a history of rest angina within the last 48 hours, associated with EKG evidence of ischemia. All subjects rece ived intravenous heparin and oral aspirin, 23 were randomly assigned t o receive intravenous DTZ and 20 to receive intravenous NTG. Both grou ps had similar baseline features and the endpoints of treatment were r ecurrence of angina, myocardial infarction, death during hospitalizati on and secondary side effects. Treatment with DTZ, when compared to NT G, resulted in a significant reduction of recurrent angina (8,7 and 59 % respectively; p<0.005), number of angina episodes per patient (0.18/-0.5 and 0.9+/-1.2 respectively; P< 0.05) and lower need for dose inc rement to control symptoms (3 and 9 patients respectively; p<0.05). Th e most common side effects observed were cephalea with NTG (60% of pat ients) and asymptomatic sinus bradicardia with DTZ (28% of patients). In each group, one patient had a myocardial infarction and one patient died. It is concluded that intravenous DTZ reduces myocardial ischemi a to a greater extent than NTG and cart be safely used in patients wit h unstable angina pectoris.