Attenuated severity of new acute ischemic events in patients with previous coronary heart disease receiving long-acting nitrates.
BACKGROUND
Platelet aggregation and secondary vasoconstriction are key events in the genesis of acute coronary syndromes.


OBJECTIVE
Since nitrates have vasodilatory and antiaggregant effects, treatment with long-acting nitrates at the time of onset of acute coronary syndromes could be associated with attenuation of their severity.


METHODS
A consecutive series of 533 patients with acute coronary syndrome and past history of coronary artery disease admitted to the Cardiology Service of a general hospital was studied. A specific questionnaire assessed the use of nitrates and other relevant drugs, as well as other clinical variables. The diagnosis of unstable angina or acute myocardial infarction (MI) was established according to clinical, electrocardiographic, and enzymatic criteria.


RESULTS
In the whole cohort, 169 patients had MI and 364 had unstable angina. Previous use of long-acting nitrates was significantly more common in patients with unstable angina (56%) than in those with MI (37%) (p < 0.0001). Multivariate analysis identified being a nonsmoker [odds ratio: 95%, confidence limits (CL) 0.37, 0.23-0.59], previous unstable angina (CL 0.62, 0.41-0.92), use of aspirin (CL 0.58, 0.41-0.92), and use of long-acting nitrates (CL 0.61, 0.40-0.93) as the independent predictors of the development of unstable angina rather than MI; of these the combination of nitrates and aspirin was the strongest predictor.


CONCLUSIONS
Long-acting nitrates as well as aspirin are suggested to have a protective or modifying effect on the development of acute coronary syndromes, favoring unstable angina rather than acute MI.
García-Dorado
D
D
Servei de Cardiologia, Hospital General Universitari Vall d'Hebron, Barcelona, Spain.
Permanyer-Miralda
G
G
Brotons
C
C
Calvo
F
F
Campreciós
M
M
Oliveras
J
J
Santos
M T
MT
Moral
I
I
Soler-Soler
J
J
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D001241:Aspirin / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D015331:Cohort Studies; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D003692:Delayed-Action Preparations; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D005996:Nitroglycerin / Q000627:therapeutic use*; D016017:Odds Ratio; D011379:Prognosis; D012008:Recurrence; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D003692:Delayed-Action Preparations; D014665:Vasodilator Agents; D005996:Nitroglycerin; D001241:Aspirin