COMMENTARY

Lessons From the Resuscitation Sessions at AHA

Lance B. Becker, MD; Graham Nichol, MD, MPH

Disclosures

January 23, 2014

In This Article

NIAMI and CATIS

Dr. Graham: I agree. There were also a couple of other studies that were presented in the same session, one of which was a study of nitrite in myocardial infarction.[7] I think you've been thinking a lot about nitrite, but what were your thoughts on that study?

Dr. Becker: What they did is they attempted to provide a dose of nitrite as they opened up an occluded artery right at the moment of reperfusion. There were some interesting and pretty good animal data to show that nitrates are turned into nitric oxide and that it has a good effect, but they didn't see any effect.

I think this is just the beginning to look at this as a potential therapy, and I suspect there are simply going to have to be a lot more studies done. There are questions that I have in terms of did they use the right dose? Did they do it long enough? The patient received the benefit of this nitrate for only about 5 minutes.

Dr. Graham: And did they use the right route? They gave it peripherally rather than directly into the coronary artery.

Dr. Becker: There are all kinds of different ways of giving nitric oxide. There are people who are looking at the ability to use it as an inhaled drug -- because you can actually put it in a gas and inhale it and that gets in very quickly -- and there are other formulations that can be used. Clearly, we have a lot more to learn about that, and I think what we've learned from this is that this particular regimen didn't seem to have any effect.

Dr. Graham: There was also a large Chinese study that evaluated blood pressure reduction in patients with acute stroke, which did not demonstrate a difference between those who had their blood pressure lowered and those who did not.[8]

Dr. Becker: And it was a very large study, and so in that sense a very interesting international source of data. Many of us would attempt to lower blood pressure acutely in the setting of a stroke, so we're going to have to reevaluate that practice as well.

Dr. Graham: I agree. We hope you've enjoyed this discussion, and thank you for observing and participating.

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