Effect of Short-Term Infusion of Sodium Nitroprusside on Mortality Rate in Acute Myocardial Infarction Complicated by Left Ventricular Failure

Cohn, Jay N.; Franciosa, Joseph A.; Francis, Gary S.; Archibald, Donald; Tristani, Felix E.; Fletcher, Ross D.; Montero, A.; Cintrón, Guillermo; Clarke, Janice; Hager, David; Saunders, Rob; Cobb, Frederick R.; Smith, Raymond A.; Loeb, Henry S.; Settle, Harold P.

doi:10.1056/nejm198205133061902

Cited by 249 publications

(72 citation statements)

References 29 publications

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“…Similar findings were obtained with respect to admission, maximum, and last scores. To investigate if the PSI score is influenced by age, the data base was separated by age 5 12 mo or > 12 mo. For each age group, a stepwise multiple logistic regression of mortality versus 4-d average PSI and age as regressor variables was performed.…”

Section: Resultsmentioning

confidence: 99%

Validation of a Physiologic Stability Index for Use in Critically Ill Infants and Children

et al. 1984

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SummaryWe developed a physiology-based scoring system, the Physiologic Stability Index (PSI) to assess severity of acute illness in the total population of pediatric Intensive Care Unit (ICU) patients. Thirty-four variables from seven physiologic systems were chosen, and the degree of abnormality of each variable was assigned a score reflecting the clinical importance of the derangements. Validity was demonstrated by comparing PSI to hospital mortality and to two other methods that reflect severity of illness, the Clinical Classification System (CCS) and the Therapeutic Intervention Scoring System (TISS). Four hundred and twentythree consecutive admissions to a multidisciplinary ICU were followed daily. Patients classified into higher CCS classes had significantly higher PSI scores ( P < 0.001), and there was a highly significant correlation (P < 0.001) between PSI and TISS scores. The linear-logistic regression of observed mortality versus PSI was highly significant (P < 0.0001) and provided an excellent fit. Highly significant differences between survivors and nonsurvivors were observed for PSI scores ( P < 0.001), as well as for composite slopes of the regression of PSI scores versus days of care ( P < 0.001). These data demonstrate validity of the PSI scoring system.

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Section: Resultsmentioning

confidence: 99%

Validation of a Physiologic Stability Index for Use in Critically Ill Infants and Children

et al. 1984

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“…The higher-than-expected incidence of free wall, septal, or papillary muscle rupture among placebo-treated patients might be at least in part a complication of untreated hypertension. The deleterious results of early nitroprusside therapy in the study of Cohn et al 25 might be a result of the "coronary steal" predicted in the above-mentioned animal preparation and clinical studies. 23' 24 Early treatment with TNG appeared to improve perfusion and to reverse segmental wall motion abnormalities more often than could be accounted for by "spontaneous" or purely time-related changes.…”

Section: Discussionmentioning

confidence: 96%

A randomized prospective trial of intravenous nitroglycerin in patients with acute myocardial infarction.

et al. 1983

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A prospective randomized study of intravenous nitroglycerin (TNG) administered for 48 hr after acute infarction was undertaken to determine whether clinical improvement and/or evidence of preservation of ischemic myocardium could be demonstrated. One hundred four patients were randomly assigned to TNG (n = 56) and placebo groups (n = 48). TNG was infused at a rate sufficient to lower mean arterial pressure 10%, monitored noninvasively. When all TNG-and placebo-treated patients were compared, no significant differences in clinical or laboratory outcomes could be demonstrated. TNG-and placebo-treated patients were retrospectively subdivided into early and late treatment groups (treatment begun <10 hr vs 3 10 hr after onset of symptoms). Early TNG treatment was associated with a lower incidence of infarct complications within the first 10 days, defined by new congestive heart failure, infarct extension, or cardiac death (15% in early TNG compared with a mean of 39% in the other three subgroups; p = .003). Mortality at 3 months was lower in the group treated early with TNG (15%) compared with a mean of 25% in the other three subgroups (p = NS). No significant differences were found in peak creatine kinase (CK) blood levels, creatine kinase infarct size, or preservation of precordial R waves by serial electrocardiographic mapping. Among 49 patients with pretreatment and day 7 to 14 posttreatment left ventricular ejection fraction measurements, improvement of 3 10% occurred in 35% of TNG patients treated early compared with 6% of those treated late with TNG, 11% of those treated early with placebo, and 0% of those treated late with placebo (p = .004). Similarly, in 68 patients in whom paired thallium scintigrams were taken, a decrease of B75% in the computer-determined thallium defect score was seen in 48% of TNG patients treated early, compared with 14% of TNG patients treated late, 33% of placebo patients treated early and 0% of placebo patients treated late (p = .039). Patients demonstrating significant scintigraphic improvement were treated earlier, tended to have less severe initial scintigraphic abnormalities, inferior rather than anterior infarctions, a longer history of angina, and no prior history of heart failure. Thus intravenous TNG could not be shown to result in significant improvement in clinical or scintigraphic outcomes when the patient population was analyzed as a whole. After retrospective subgroup analysis, intravenous TNG could be shown to protect ischemic myocardium in the subset of patients with smallto-moderate sized myocardial infarctions when treatment was begun within 10 hr of the onset of symptoms. The results of this trial also suggest that future clinical trials designed to show a reduction in infarct size might limit patient entry to those admitted early after symptom onset and those with significant abnormalities in their admission scintigraphic studies. Larger-scale studies are needed to determine whether TNG therapy can significantly reduce mortality and to further define the...

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“…Also, in patients with coronary artery disease, it may cause a significant reduction in coronary blood flow secondary to coronary steal phenomenon [12]. In a large randomized controlled trial among patients with acute myocardial infarction and elevated left ventricular filling pressure, the use of nitroprusside within 9 hours after the onset of chest pain, resulted in increased mortality [13]. Since it is a very potent agent with rapid onset of action and short half-life, it should only be used with intra-arterial blood pressure monitoring in an intensive care setting [6].…”

Section: Pharmacological Managementmentioning

confidence: 99%

Management of Hypertensive Emergencies

Penumetsa¹

2013

J Hypertens

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Effect of Short-Term Infusion of Sodium Nitroprusside on Mortality Rate in Acute Myocardial Infarction Complicated by Left Ventricular Failure

Cited by 249 publications

References 29 publications

Validation of a Physiologic Stability Index for Use in Critically Ill Infants and Children

Validation of a Physiologic Stability Index for Use in Critically Ill Infants and Children

A randomized prospective trial of intravenous nitroglycerin in patients with acute myocardial infarction.

Management of Hypertensive Emergencies

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