The effect of trinitroglycerine injection on angiographic complications

Currently the ischemic heart disease (IHD) is common worldwide. Coronary angiography is gold standard for detecting coronary artery disease. Death, myocardial infarction, nausea, coronary vessels spasm, chest pain, bradyarrhythmia, hypotension, and hypertension are among the common complications occurring following angiography.

The aim of this study was to investigate the effect of simultaneous administration of trinitroglycerine (TNG) and the contrast agent on early complications of angiography.

This was a clinical trial carried out in Isfahan Shahid Chamran Hospital in 2005. Patients were randomly allocated to two intervention (n=111) and placebo (n=112) groups. Nausea, coronary vessels spasm, chest pain, bradyarrhythmia, and systolic and diastolic blood pressure in both intervention (TNG plus contrast agent) and placebo (distilled water plus contrast agent) groups were investigated during and after angiography.

The mean age in intervention and placebo groups were 59.93± 9.14 and 59.37±10.12 years, respectively. Also, sex distribution showed no significant difference. Between TNG group and placebo group we had considering the nausea (4.5% vs 6.2%), coronary vessels spasm (0.9% vs 5.4%), chest pain (1.8% vs 6.3%), and bradyarrhythmia (7.1% vs 7.1%) respectively, that had not any significant difference. However, the mean maximum systolic and diastolic blood pressures were significantly lower in TNG group compared to placebo group (p=0.001).

Based on data obtained in the present study, except for blood pressure no benefit in simultaneous administration of TNG and the contrast agent on early complication of angiography was demonstrated. Further investigations using different dose, time tables and also selection of high risk patients are recommended. Furthermore, the late complications and mortality as well as the cost-effectiveness are the subjects deserving more attention.