Chest pain relief by nitroglycerin does not predict active coronary artery disease.
BACKGROUND
The belief that chest pain relief with nitroglycerin indicates the presence of active coronary artery disease is common. However, this hypothesis has not been tested.


OBJECTIVE
To define the diagnostic and prognostic value of chest pain relief with nitroglycerin.


METHODS
Prospective observational cohort study.


METHODS
Urban community teaching hospital.


METHODS
459 consecutive patients with chest pain admitted through the emergency department who received nitroglycerin from emergency services personnel or an emergency department nurse. Follow-up was obtained by telephone contact at 4 months.


METHODS
Chest pain relief was defined as a decrease of at least 50% in patients' self-reported pain within 5 minutes of the initial dose of sublingual or spray nitroglycerin. Active coronary artery disease was defined as any elevated serum enzyme levels, coronary angiography demonstrating a 70% or greater stenosis, or a positive exercise test result.


RESULTS
Nitroglycerin relieved chest pain in 39% of patients (181 of 459). In patients with active coronary artery disease as the likely cause of their chest pain, 35% (49 of 141) had chest pain relief with nitroglycerin. In contrast, in patients without active coronary artery disease, 41% (113 of 275) had chest pain relief (P > 0.2). Four-month clinical outcomes were similar in patients with or without chest pain relief with nitroglycerin (P > 0.2).


CONCLUSIONS
These data suggest that, in a general population admitted for chest pain, relief of pain after nitroglycerin treatment does not predict active coronary artery disease and should not be used to guide diagnosis.
Henrikson
Charles A
CA
Johns Hopkins Bayview Medical Center, Baltimore, Maryland 21224, USA.
Howell
Eric E
EE
Bush
David E
DE
Miles
J Shawn
JS
Meininger
Glenn R
GR
Friedlander
Tracy
T
Bushnell
Andrew C
AC
Chandra-Strobos
Nisha
N
D000465:Algorithms; D002637:Chest Pain / Q000188:drug therapy* / Q000209:etiology; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis*; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008396:Maryland; D008875:Middle Aged; D005996:Nitroglycerin / Q000627:therapeutic use*; D011379:Prognosis; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014665:Vasodilator Agents / Q000627:therapeutic use*
D014665:Vasodilator Agents; D005996:Nitroglycerin