Clinical InvestigationsNesiritide in congestive heart failure associated with acute coronary syndromes: a pilot study of safety and efficacy☆
Section snippets
Methods
This study retrospectively analyzed the subset of patients in the VMAC trial who reported an ACS within 7 days before enrollment. The diagnosis of ACS was made by the investigator based on electrocardiographic, serum ischemia markers, and clinical evidence. For this analysis we used the diagnosis of acute myocardial infarction or unstable angina contained in the original VMAC case report forms, as noted in the Coding Symbols for “Thesaurus of Adverse Reaction Terms” dictionary.4 The
Results
Sixty-one patients were defined as having an ACS within 7 days of enrollment. Among these patients, during the initial 3-hour placebo controlled arm, 21 received standard therapy, 20 received NTG, and 20 received nesiritide. After the initial 3-hour period, placebo patients were rerandomized so that there were a total of 34 patients in the NTG group and 27 patients in the nesiritide group. Four patients in the nesiritide group were randomized to adjustable dose nesiritide. Because these 4
Discussion
Because both ACS and HF share similar risk factors, patients with these concurrent conditions will present for medical care. As many as 14% of acutely decompensated HF patients presenting to an emergency department have an underlying acute coronary syndrome.2 Because HF treatment is commonly initiated before serum cardiac marker results are available, it is important that nesiritide is safe for use both in HF and ACS.
Though a small cohort, this analysis suggests nesiritide is safe for the
Conclusion
This analysis suggests that nesiritide is safe for the management of decompensated HF when there is an accompanying ACS. A larger study is warranted to further evaluate the role of nesiritide in patients with acute coronary syndromes.
Acknowledgements
The authors would like to thank Mei Cheng, PhD, Scios Inc., and Gerri Smoluk. PhD, Scios Inc.; thanks also to Charlotte Melton for secretarial support.
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Cited by (22)
2014 AHA/acc guideline for the management of patients with Non-ST-Elevation acute coronary syndromes: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
2014, Journal of the American College of CardiologyCitation Excerpt :The decision to administer nitrates should not preclude therapy with other proven mortality-reducing interventions such as beta blockers. Intravenous nitroglycerin is beneficial in patients with HF, hypertension, or symptoms that are not relieved with sublingual nitroglycerin and administration of a beta blocker (219,221–224). Patients who require intravenous nitroglycerin for >24 hours may require periodic increases in the infusion rate and use of nontolerance-producing regimens (e.g., intermittent dosing) to maintain efficacy.
2014 AHA/ACC guideline for the management of patients with Non-ST-Elevation acute coronary syndromes: Executive summary: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
2014, Journal of the American College of CardiologyCitation Excerpt :Level of Evidence: C) Intravenous nitroglycerin is indicated for patients with NSTE-ACS for the treatment of persistent ischemia, heart failure (HF), or hypertension (106–111). ( Level of Evidence: B)
Critical review and recommendations for nesiritide use in the emergency department
2005, Journal of Emergency MedicineNew pharmacologic approaches for the perioperative treatment of ischemic cardiogenic shock
2005, Journal of Cardiothoracic and Vascular AnesthesiaA meta-analysis of the clinical efficacy of rhBNP in treating patients with acute myocardial infarction and heart failure
2021, American Journal of Translational ResearchEffectiveness and safety of recombinant human brain natriuretic peptide in the treatment of acute myocardial infarction in elderly in combination with cardiac failure
2017, Pakistan Journal of Medical Sciences
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Supported by Scios Inc., Sunnyvale, California.