Nitrates for myocardial salvage in the 1990s

Low-dose intravenous nitroglycerin infusion for the first 48 h is becoming routine in the management of acute myocardial infarction in North America. It is most widely used as primary therapy in patients admitted more than 6 h after acute infarction. Such therapy has been shown to limit infarct size, infarct complications and remodeling. However, it is being applied increasingly more as an adjunct before, during and after thrombolytic therapy. Several trials are underway to test the effectiveness of more prolonged therapy, with early intravenous nitroglycerin followed by buccal or oral formulations for several weeks, in further limitation of ventricular remodeling, dilatation, aneurysm formation and in preserving function. Nitrates may prove to be a useful adjunct or alternative to angiotensin-converting-enzyme (ACE) inhibitors for long-term therapy.