Combination Therapy With Nicardipine and Isosorbide Dinitrate to Prevent Spasm in Transradial Percutaneous Coronary Intervention (from the NISTRA Multicenter Double-Blind Randomized Controlled Trial).

Autor: Bouchahda N; Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16, Fattouma Bourguiba University Hospital, Rue du 1er juin, Monastir, Tunisia. Electronic address: nidhalbouchahda@gmail.com., Ben Abdessalem MA; Cardiology Department, Université de Sousse, Laboratoire de Recherche: interactions cardiopulmonaires LR14ES05, Farhat Hached University Hospital, Tunisia., Ben Hlima N; Cardiology Department,Université de Sousse, Kairouen Ibn el Jazzar University Hospital, Tunisia., Ben Messaoud M; Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16, Fattouma Bourguiba University Hospital, Rue du 1er juin, Monastir, Tunisia., Denguir H; Cardiology Department, University of Monastir, Gabes University Hospital, Tunisia., Boussaada MM; Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16, Fattouma Bourguiba University Hospital, Rue du 1er juin, Monastir, Tunisia., Saoudi W; Cardiology Department, Université de Sousse, Laboratoire de Recherche: interactions cardiopulmonaires LR14ES05, Farhat Hached University Hospital, Tunisia., Jamel A; Cardiology Department,Université de Sousse, Kairouen Ibn el Jazzar University Hospital, Tunisia., Hassine M; Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16, Fattouma Bourguiba University Hospital, Rue du 1er juin, Monastir, Tunisia., Bouraoui H; Cardiology Department, Université de Sousse, Laboratoire de Recherche: interactions cardiopulmonaires LR14ES05, Farhat Hached University Hospital, Tunisia., Mahjoub M; Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16, Fattouma Bourguiba University Hospital, Rue du 1er juin, Monastir, Tunisia., Mahdhaoui A; Cardiology Department, Université de Sousse, Laboratoire de Recherche: interactions cardiopulmonaires LR14ES05, Farhat Hached University Hospital, Tunisia., Jeridi G; Cardiology Department, Université de Sousse, Laboratoire de Recherche: interactions cardiopulmonaires LR14ES05, Farhat Hached University Hospital, Tunisia., Betbout F; Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16, Fattouma Bourguiba University Hospital, Rue du 1er juin, Monastir, Tunisia., Gamra H; Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16, Fattouma Bourguiba University Hospital, Rue du 1er juin, Monastir, Tunisia.
Jazyk: angličtina
Zdroj: The American journal of cardiology [Am J Cardiol] 2023 Feb 01; Vol. 188, pp. 89-94. Date of Electronic Publication: 2022 Dec 05.
DOI: 10.1016/j.amjcard.2022.11.005
Abstrakt: Verapamil and nitroglycerin are widely used to prevent radial artery spasm (RAS) during percutaneous cardiovascular procedures. However, these agents are not typically available in most African countries and consequently, isosorbide dinitrate is often the only spasmolytic treatment. Our aim was to compare the efficacy of isosorbide dinitrate alone versus isosorbide dinitrate used together with nicardipine to prevent RAS during transradial coronary procedures. This was a randomized controlled double-blind multicenter trial. Patients (n = 1,523) were randomized to receive either a sole therapy of isosorbide dinitrate (n = 760) or the combination of isosorbide dinitrate and nicardipine (n = 763). Our primary end point was the occurrence of RAS; defined as considerable perceived hindrance of catheter advancement. Our secondary end points were severe RAS; defined as (1) severe arm pain, (2) the need for either morphine or midazolam treatment, and (3) necessity for crossover to the contralateral radial or femoral artery. RAS incidence was reduced with the combination therapy versus isosorbide dinitrate alone (15% vs 25%, p <0.001), with a number needed to treat of 10 patients. There was also a significant reduction in the incidence of the secondary end points with combination therapy (3.6% vs 8.2%, p <0.001), with a number needed to treat of 22 patients. This result was driven by reductions in both femoral crossover (0.5% vs 2.4%, p = 0.003) and the use of morphine or midazolam injections (1.6% vs 3.5%, p = 0.02) with combination therapy. In conclusion, we demonstrated the superiority of the combination therapy of isosorbide dinitrate and nicardipine over isosorbide dinitrate alone in reducing the incidence of RAS.
Competing Interests: Disclosures The authors have no conflicts of interest to declare.
(Copyright © 2022 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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