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Nitrates in myocardial infarction: a current perspective

J L Morris1, J C Cowan

  • 1Department of Cardiology, General Infirmary, Leeds, United Kingdom.

The Canadian Journal of Cardiology
|April 1, 1995
PubMed
Summary
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Nitrate therapy for acute myocardial infarction showed a potential early benefit in large trials, though overall mortality reduction was not statistically significant. Further research is needed to clarify benefits in specific patient subgroups.

Area of Science:

  • Cardiology
  • Pharmacology

Background:

  • Nitrates are established treatments for various cardiovascular conditions, including angina and heart failure.
  • Intravenous nitrate therapy was previously suggested to reduce mortality in acute myocardial infarction by 35% based on meta-analysis.
  • Recent large-scale trials (GISSI-3 and ISIS-4) investigated nitrate use during and after acute infarction.

Purpose of the Study:

  • To evaluate the efficacy of nitrate therapy in acute myocardial infarction.
  • To reconcile conflicting results between earlier meta-analyses and large clinical trials.
  • To determine the current role of nitrates in managing acute myocardial infarction.

Main Methods:

  • Analysis of data from two large randomized controlled trials (GISSI-3 and ISIS-4).
  • Comparison of outcomes in patients receiving nitrate therapy versus placebo during and after acute myocardial infarction.

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  • Review and comparison with previous meta-analysis findings.

    • Main Results:

    • The large-scale trials (GISSI-3 and ISIS-4) did not demonstrate a statistically significant reduction in mortality with nitrate therapy.
    • A meta-analysis suggested a 35% mortality reduction, contrasting with the mega-trial results.
    • Suggestive evidence for a potential early benefit of nitrate therapy was observed in the mega trials, albeit smaller than previously indicated.

    Conclusions:

    • The overall role of nitrates in acute myocardial infarction remains uncertain.
    • Any existing benefit from nitrate therapy is likely smaller than previously estimated and may be confined to specific subgroups of patients.
    • Further clinical trials are necessary to precisely define the potential early benefits and identify patient subgroups who may benefit from nitrate administration.