Nesiritide in congestive heart failure associated with acute coronary syndromes: A pilot study of safety and efficacy

Background: To compare the safety and efficacy of nesiritide versus intravenous nitroglycerin (NTG) in patients with acute coronary syndromes enrolled in the Vasodilation in the Management of Acute Congestive heart failure trial. Methods and Results: Retrospective review of Vasodilation in the Management of Acute Congestive heart failure trial data for heart failure associated with prospectively diagnosed acute coronary syndromes. Sixty-one patients were included; 34 received nesiritide and 27 received NTG. Pulmonary capillary wedge pressure was measured in right heart-catheterized patients (11 nesiritide, 9 NTG). Death at 6 months occurred in 2 nesiritide and 5 NTG patients (P > .2). Hypotension occurred in 4 nesiritide and 3 NTG patients (P > .6). At 24 hours, pulmonary capillary wedge pressure improvements persisted (P = .001) in the nesiritide group, whereas the NTG group had returned to baseline (P > .1). In non-right heart-catheterized patients, 24-hour dyspnea scores were at least moderately improved in all nesiritide and 71% of NTG (P = .031). At least minimal dyspnea improvement was seen in 100% of nesiritide versus 71% of NTG patients (P > .3), and 6-hour global clinical scores were at least moderately better in 75% of nesiritide versus 32% of NTG (P = .031). In non-right heart-catheterized patients, there were no 30-day readmissions with nesiritide versus 17% with NTG (P > .2). Conclusions: Nesiritide is as safe as NTG in heart failure patients with acute coronary syndromes.