Oral ISDN for the treatment of patients with acute myocardial infarction.

In a controlled randomized trial the effect of treatment with 60 mg orally administered ISDN in patients with acute myocardial infarction was studied. Besides the usual clinical investigations, hemodynamics were checked; pulmonary artery pressure and cardiac output during the first 4 days were measured. 509 patients were included in the trial. Based on other researchers' considerations about limitation of infarct size we formed a subgroup of 132 patients to be treated within 8 h after onset of symptoms. The mortality for the entire ISDN-group was not influenced compared with that for the control group. If treatment with ISDN was started within the first 8 h after onset of symptoms of acute myocardial infarction, mortality in this group was significantly lower than that in the control group. In the group of patients receiving treatment within the first 8 h we found positive effects: a fall of pulmonary artery pressure with consecutive rise of cardiac output, mainly in patients showing high left ventricular end-diastolic filling pressures. In the treated group we found a significant decrease in arrhythmias and angina pectoris. When left ventricular hemodynamics were tested before discharge from the hospital patients treated with ISDN during the first 8 h again showed favorable results. We conclude that treatment with ISDN in the early phase of acute myocardial infarction is beneficial particularly for patients with high left ventricular filling pressures.