Key result
Discharge nitrates show no overall mortality benefit, but link to higher death in LVEF <.
Why the study?
The association between long-acting nitrates and long-term outcomes in CAD remains controversial, and whether LVEF modifies this relationship is not well characterized.
Does discharge prescription of nitrates improve all-cause mortality and MACE in patients with coronary artery disease across different left ventricular ejection fractions?
Cohort (n=2,404)
No
Does discharge prescription of nitrates improve all-cause mortality and MACE in patients with coronary artery disease across different left ventricular ejection fractions?
In patients with coronary artery disease, discharge on long-acting nitrates was associated with significantly increased risks of all-cause mortality and MACE exclusively in the subgroup with reduced LVEF (<45%), suggesting cautious use in this population.
Discharge nitrates may warrant caution in CAD with LVEF <45%; hypothesis-generating and should not yet change practice.
Background Long-acting nitrates are widely prescribed in coronary artery disease (CAD), yet their association with long-term outcomes remains controversial. Whether left ventricular ejection fraction (LVEF) modifies this relationship has not been well characterized. Methods We conducted a single-center retrospective cohort study using the Guizhou Provincial People's Hospital CAD database. Adults (≥18 years) who underwent coronary angiography between July 2012 and September 2016 and met angiographic criteria for CAD (≥50% stenosis in ≥1 proximal epicardial coronary artery) were eligible if LVEF and discharge medications were available. Patients were stratified by LVEF (<45%, 45%–55%, >55%) and by discharge prescription of any nitrate (mononitrate or dinitrate). The primary endpoint was all-cause death. The secondary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Kaplan–Meier methods and multivariable Cox regression were used to evaluate associations. Results Among 2,404 patients followed for 27.2 ± 13.5 months, 1,153 (48.0%) were discharged on nitrates. In the overall cohort, discharge on nitrates was not associated with all-cause death or MACE. In contrast, among patients with LVEF < 45%, nitrates at discharge were linked to higher cumulative incidences of all-cause death and MACE (log-rank P = 0.024 and 0.029, respectively) and remained independently associated after adjustment [all-cause death: hazard ratio (HR) 2.14, 95% confidence interval (CI) 1.15–3.96; MACE: HR 1.91, 95% CI 1.07–3.43]. No significant associations were observed in the LVEF 45%–55% or >55% strata. Conclusion In this CAD cohort, nitrates were commonly prescribed at discharge. An adverse association with long-term outcomes was confined to patients with reduced LVEF, supporting cautious use in this subgroup and highlighting the need for prospective confirmation.
No takes yet. Share an insight, caveat, or question.
Liu et al. (2026) conducted a cohort in Coronary artery disease (n=2,404). Nitrates vs. No nitrates was evaluated on All-cause death (HR 1.08, 95% CI 0.75-1.54, p=0.695). Nitrates prescribed at discharge were not associated with mortality overall, but were linked to a higher risk of all-cause death (HR 2.14) in patients with left ventricular ejection fraction <45%.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: