Nitroglycerin use preceding primary percutaneous coronary intervention is associated with adverse clinical outcomes in elderly patients with acute coronary syndrome

Background The primary care for acute coronary syndrome (ACS) includes the administration of nitroglycerin (GTN). This study aimed to investigate the association between the use of GTN before percutaneous coronary intervention (PCI) for ACS and clinical outcomes. Methods and Results Nine-hundred and forty-seven patients who underwent PCI for ACS were examined and classified into two groups: those who were treated with GTN before PCI (GTN group) and those who were not (non-GTN group). The incidence of major adverse cardiovascular events (MACE), which consist of all-cause mortality, myocardial infarction, stroke, and rehospitalization for heart failure at 1 year, was compared between the two groups. This study identified 289 patients with ACS who used GTN preceding PCI. Pre-PCI systolic blood pressure was significantly lower in the GTN group than in the non-GTN group (median (interquartile range); 130.0 (112.5-144.2) mmHg vs. 142.0 (115.0-160.0) mmHg, respectively, p = 0.03). Multivariate Cox regression analysis indicated that GTN use preceding PCI was an independent determinant for the incidence of MACE (hazard ratio, 1.64; 95% confidence interval, 1.17-2.31; p = 0.004). Overall, the incidence of MACE 1 year after PCI for ACS was significantly higher in the GTN group than in the non-GTN group (log-rank test, p = 0.02); however, this trend was consistently found in elderly patients aged ≥ 75 years (p = 0.002) but not in non-elderly patients aged < 75 years (p = 0.77). Conclusions GTN use preceding PCI for ACS is associated with lower blood pressure and adverse clinical outcomes in elderly patients.