Analysis of coronary responses to various doses of intracoronary nitroglycerin.

Abstract

We studied the degree of coronary artery dilation resulting from increasing doses of intracoronary nitroglycerin (NTG). Heart rate, aortic pressure and coronary artery angiograms were recorded before and after 5-, 50-, 150- and 250-microgram doses of NTG infused into the left main coronary artery. Coronary artery diameters were measured by a magnification angiographic technique. After intracoronary NTG, heart rate was unchanged 2 minutes after each dose. Mean aortic pressure was unchanged after 5 microgram (NS), but declined 5 mm Hg (mean) after 50 microgram, 9 mm Hg after 150 microgram and 18 mm Hg after 250 microgram (all p less than 0.05) compared with before NTG. The maximal increase in diameter occurred after 150 microgram, and no additional increase was seen after 250 microgram. After 5- and 50-microgram doses, 67% and 75% maximal dilation responses, respectively, were observed. Compared with coronary artery diameter before NTG, the 150-microgram dose increased the diameter of left main coronary artery by 5%, proximal coronary artery segments by 9%, middle segments by 19%, distal segments by 34%, collateral-filled coronary arteries by 38%, coronary artery stenoses by 5%, and small coronary arteries (0.4-1.0 mm) by 54%. These data indicate that relatively small doses of intracoronary NTG produce potentially important coronary artery dilation without important changes in heart rate and aortic pressure. These observations should prove helpful in choosing dosage schedules for intracoronary NTG.