Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
To the Editor: Dr Young and the Vasodilation
in the Management of Acute [congestive heart failure] CHF (VMAC) investigators1 found that, among patients with decompensated CHF,
nesiritide resulted in only a 2-mm improvement in pulmonary capillary wedge
pressure (PCWP) compared with nitroglycerin and a 4-mm improvement compared
with placebo at both 3 and 24 hours. Although they claimed nesiritide improves
hemodynamic function, this small change is of no clinical significance. Subjective
dyspnea, as well as all other parameters, were not different between the groups.
At 7 days, there were 4 deaths in the nesiritide group and 1 death in the
nitroglycerin group, as well as a 4% greater 6-month mortality with nesiritide.
The similar baseline characteristics argue against the differences being due
to sicker patients randomized to nesiritide. Another recent study of nesiritide2 also showed minimal improvement, but in the presence
of significant and persistent hypotension.
Dunavant S. Nesiritide vs Nitroglycerin for Decompensated Congestive Heart Failure. JAMA. 2002;288(5):571-573. doi:10.1001/jama.288.5.571