Key result
Continuous nitrates linked to ~118% higher cardiac event risk after healed MI.
Why the study?
The effects of chronic continuous dosing of nitrates on cardiac events in patients with severe acute myocardial infarction were unclear.
Does chronic use of continuous dosing of nitrates prevent cardiac events in patients with severe acute myocardial infarction?
Cohort (n=1,303)
Does chronic use of continuous dosing of nitrates prevent cardiac events in patients with severe acute myocardial infarction?
Chronic continuous dosing of nitrates in patients with healed severe myocardial infarction does not prevent, and may significantly increase the risk of, cardiac events, especially in those with Killip class II-IV.
Answers are grounded in this paper and cite their sources.
Hypothesis-generating for harm with continuous nitrates in healed MI; prospective trials needed before changing practice.
This study was performed to investigate the effects of the chronic use of continuous, not eccentric, dosing of nitrates on cardiac events in patients with severe acute myocardial infarction. A total of 1,303 patients with healed myocardial infarction were divided into two groups: treatment with nitrates or nontreatment. Primary end points were nonfatal and fatal recurrent myocardial infarction, death from congestive heart failure and sudden death. Among the 725 patients treated with nitrates, 45 patients (6.2%) experienced cardiac events during the observation period, whereas only 17 of the 578 patients treated without nitrates (2.9%) had cardiac events. This difference was statistically significant (p < 0.01; odds ratio 2.18, 95% confidence interval 1.24-3.86). In Killip class II-IV patients, the incidence of cardiac events in patients with nitrates was significantly greater than in patients without nitrates (18.8 vs. 3.5%, p < 0.05). The chronic use of continuous, not eccentric, dosing of nitrates did not prevent cardiac events in patients with severe acute myocardial infarction.
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Kanamasa et al. (2000) conducted a cohort in Severe acute myocardial infarction (n=1,303). Continuous dosing of long-term nitrates vs. Nontreatment (without nitrates) was evaluated on Nonfatal and fatal recurrent myocardial infarction, death from congestive heart failure and sudden death (OR 2.18, 95% CI 1.24-3.86, p=< 0.01). Continuous dosing of long-term nitrates was associated with increased cardiac events compared to no nitrates in patients with healed myocardial infarction.
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