[Short-term versus long-term use of nitrates in acute myocardial infarction]

While previous experimental and small-scaled clinical studies have shown intravenous administration of nitroglycerin in the setting of acute myocardial infarction reduced infarct size and diminished the frequency of mechanical complications, its effect on short-term and long-term outcome has not been established. Recently, two large-scaled clinical trials, GISSI-3 and ISIS-4, have demonstrated unexpected neutral effect of nitrates on subacute phase mortality after myocardial infarction. Long-term nitrate treatment, however, has been indicated by three independent clinical studies that it may increase cardiac events in patients with healed myocardial infarction. Although a large-scaled randomized clinical trial is required to confirm the deleterious effect of nitrates on long-term outcome after myocardial infarction, routine use of nitrates in chronic phase of coronary heart disease cannot be recommended.