Nitrates as a Marker of Multiple Co-morbidities and Increased Mortality in Patients Undergoing Percutaneous Coronary...

Area of Science:

• Cardiology
• Interventional Cardiology
• Pharmacology

Background:

• Guidelines recommend various anti-anginal medications for stable ischemic heart disease (SIHD).
• Limited data exists on comparative effectiveness of anti-anginal regimens.
• The impact of anti-anginal drugs on outcomes after elective percutaneous coronary intervention (PCI) is not well understood.

Purpose of the Study:

• To investigate the association between commonly used anti-anginal medications and outcomes following elective PCI in SIHD patients.
• To identify if specific anti-anginal therapies influence in-hospital mortality post-PCI.

Main Methods:

• Retrospective analysis of 33,568 patients undergoing non-emergent PCI in 2015 from the New York State (NYS) PCI Reporting System.
• Primary endpoint: all-cause in-hospital mortality.
• Evaluation of associations between anti-anginal medication use (nitrates, beta-adrenergic blockers, calcium channel blockers, ranolazine) and PCI outcomes.

Main Results:

• Nitrate therapy, even in combination with other agents, was significantly associated with increased post-elective PCI in-hospital mortality.
• Beta-adrenergic blockers, calcium channel blockers, and ranolazine were not associated with increased post-PCI mortality.

Conclusions:

• In SIHD patients undergoing elective PCI, nitrate use, not beta-blockers, calcium channel blockers, or ranolazine, was linked to higher mortality.
• Increased mortality with nitrates may reflect more advanced disease burden rather than direct drug effects.
• Further research is needed to determine optimal anti-anginal medical therapy to improve PCI outcomes.