Mja. Williams et al., Randomised comparison of the effects of nicardipine and esmolol on coronary artery wall stress: implications for the risk of plaque rupture, HEART, 84(4), 2000, pp. 377-382
Citations number
34
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objective-To determine whether the beta blocker esmolol reduces coronary ar
tery wall stress more than the short acting dihydropyridine calcium antagon
ist nicardipine.
Design-Randomised double blind placebo controlled trial.
Setting-Tertiary cardiology centre.
Patients-Patients with coronary artery disease.
Interventions-20 patients were randomised double blind to an infusion of ni
cardipine (n = 10) or esmolol (n = 10) titrated to reduce systolic blood pr
essure by 20 mm Hg. Main outcome measures-Peak systolic wall circumferentia
l stress.
Results-Esmolol reduced peak coronary stress by a mean of 0.17 x 10(6) dyn/
cm(2) (95% confidence interval (CI) 0.14 to 0.21 x 10(6) dyn/cm(2)) compare
d with a reduction of 0.07 x 10(6) dyn/cm(2) (95% CI 0.05 to 0.10 x 100 dyn
/cm(2)) after nicardipine. Peak systolic radius was reduced by 0.04 mm (95%
CI 0.03 to 0.06 mm) after esmolol compared with an increase of 0.08 mm (95
% CI 0.05 to 0.10 mm) after nicardipine. Heart rate increased by 11.5 beats
/min (95% CI 6.9 to 16.2 beats/min) after nicardipine and decreased by 5.3
beats/min (95% CI 1.9 to 8.6 beats/min) after esmolol.
Conclusions-Intravenous esmolol is more effective than nicardipine at reduc
ing circumferential coronary artery wall stress.