Forty patients with
coronary artery disease and scintigraphically proven
myocardial ischemia were randomized into 2 groups receiving 4 weeks of treatment with either 120 mg of
isosorbide dinitrate (ISDN) release or 60 mg of
nifedipine release. Control exercise testing and myocardial scintigraphy were continued until anginal pains occurred, and repeated at identical individual workloads at the end of the 4 weeks of
drug therapy. Myocardial scintigrams were evaluated by quantitative recording of counts in 60 segments/frame. Twenty patients in the ISDN group (group I) exhibited 47 significantly ischemic areas. The remaining 20 patients (group II), treated with
nifedipine, had 50 ischemic areas before
therapy. In the ischemic areas in group I, there was a mean difference of 30.9% between counts at rest and during exercise in the pretreatment period, and a difference of 18.1% after
therapy (39.0%). In group II, the pretreatment difference was 28.8%, decreasing to 20.6% after
therapy (17.8%). Both groups of patients were subsequently subdivided into 3 subsets: (1) significantly improved perfusion, (2) significant worsening, and (3) unchanged myocardial perfusion. Group I had 59.5% of areas with significant improvement and 10.6% of areas with significant worsening. In 29.7% of the areas, the findings were unchanged. Group II had improvement in 40% of areas, of significantly worsened areas in 6%, and unchanged areas in 54%, in both groups
myocardial ischemia was reduced by
therapy, but ISDN improved myocardial perfusion to a considerably greater extent than did
nifedipine.