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Angiology
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Coronary Arteriographic Findings During Early Hours of Acute Myocardial Infarction: Response to Intracoronary Injection of Nitrates

Shingo Omote

Division of Cardiology, Shizuoka City Hospital, Shizuoka City, Japan

Hirofumi Yasue

Division of Cardiology, Shizuoka City Hospital, Shizuoka City, Japan

Akinori Takizawa

Division of Cardiology, Shizuoka City Hospital, Shizuoka City, Japan

Masao Nagao

Division of Cardiology, Shizuoka City Hospital, Shizuoka City, Japan

Hiromitsu Hyon

Division of Cardiology, Shizuoka City Hospital, Shizuoka City, Japan

Shinichiro Nishida

Division of Cardiology, Shizuoka City Hospital, Shizuoka City, Japan

Minoru Horie

Division of Cardiology, Shizuoka City Hospital, Shizuoka City, Japan

We performed coronary arteriography and gave intracoronary injection of nitrates within 8 hours after the onset of symptoms of acute myocardial infarction in eighteen patients. Improved distal filling or patency of the total occluded coronary artery after intracoronary injection of nitrates occurred in 4 of 18 patients. In one of four patients the first intracoronary nitrates injection failed to release the initial total occlusion, but after intracoronary Urokinase administration, the second nitrates injection succeeded to dilate the com pletely occluded coronary artery. Coronary arteriography was again per formed in sixteen patients in the chronic stage (4-15 weeks after the onset of acute myocardial infarction) and ergonovine malaete was injected intraven ously in seven patients. Focal spasm was induced by ergonovine injection in three patients in one of whom intracoronary nitrates failed to release the complete obstruction in the acute stage.

We conclude that coronary spasm as well as intracoronary thrombosis plays an important role in the production of acute myocardial infarction.

Angiology, Vol. 34, No. 8, 553-560 (1983)
DOI: 10.1177/000331978303400807
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