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Which patients with coronary artery disease should include oral nitrates on their discharge medication list?
Chen Xueying1,2, Zhang Hua3, Zhao Lujing1
1Department of Cardiology, Jining Key Laboratory for Diagnosis and Treatment of Cardiovascular Diseases, Affiliated Hospital of Jining Medical University, Jining, Shandong, China.
Insights
Oral nitrates at discharge did not correlate with major adverse cardiovascular events (MACEs) in coronary artery disease (CAD) patients. However, nitrates increased MACEs in hypertensive patients and potentially those with low uric acid.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Coronary artery disease (CAD) management involves optimizing discharge medications.
- The role of oral nitrates in preventing major adverse cardiovascular events (MACEs) after coronary angiography (CAG) requires clarification.
Purpose of the Study:
- To investigate the association between oral nitrates in discharge medication and MACEs in CAD patients.
- To identify patient subgroups where oral nitrates might influence MACEs post-CAG.
Main Methods:
- Retrospective cohort study of 2979 CAD patients.
- Follow-up for MACEs over a mean of 4.42 years.
- Multivariate Cox proportional hazards and stratified analyses were employed.
Main Results:
- No overall association was found between oral nitrates and MACEs in CAD patients (p > 0.05).
- Hypertensive patients on oral nitrates showed a significantly higher incidence of MACEs (HR: 1.67, p = 0.0046).
- A trend towards increased MACEs was observed in patients with low uric acid on oral nitrates (HR: 1.44, p = 0.0525).
Conclusions:
- Oral nitrates at discharge are not associated with MACEs in the general CAD population.
- Concomitant hypertension or low uric acid levels may modify the risk associated with oral nitrates in CAD patients.
- Careful consideration and monitoring are advised when prescribing oral nitrates to specific CAD patient subgroups.
Background:
Which patients with coronary artery disease (CAD) should have oral nitrates on their discharge medication list after coronary angiography (CAG)? To assess the relationship between oral nitrates included in the discharge medication list and major adverse cardiovascular events (MACEs) among CAD patients, we designed this retrospective cohort study.
Methods:
A total of 2979 CAD patients hospitalised in the Department of Cardiology, Affiliated Hospital of Jining Medical University from May 2013 to October 2015 were enrolled, grouped according to whether oral nitrates were included at discharge after CAG, and followed up for MACEs for a mean of 4.42 years after discharge. The primary endpoint was MACEs. Multivariate Cox proportional hazards models were used to analyses potential confounding factors. Stratified analysis was used to observe the relationship between oral nitrates and MACEs by different covariates.
Results:
The median follow-up time was 4.61 years, and 296 (9.94%) patients experienced MACEs. Multivariate Cox proportional hazards model analysis showed no association between oral nitrates on the discharge medication list and the occurrence of MACEs among patients with CAD (p > 0.05) after adjusting for some covariates, such as SYNTAX score (hazard ratio (HR): 1.18, 95% confidence interval (CI): 0.90-1.55, p = 0.2420). Stratified analysis revealed a higher incidence of MACEs among hypertensive patients prescribed oral nitrates at discharge (HR: 1.67, 95% confidence CI: 1.13-2.46, p = 0.0046). However, prescribing nitrates at discharge for patients with low uric acid levels increased the incidence of MACEs, which showed a possible trend towards significance (HR: 1.44, 95% CI: 0.99-2.09, p = 0.0525).
Conclusion:
There was no association between oral nitrates included in the discharge medication list and the development of MACEs among patients with CAD after adjusting for some covariates, such as SYNTAX score. Oral nitrates after discharge for CAD patients combined with hypertension increased the occurrence of MACEs. Oral nitrates after discharge for CAD patients combined with low uric acid levels may increase theoccurrence of MACEs, and close monitoring for any adverse events is recommended.
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