[Nitrate therapy during and after acute myocardial infarction].
BACKGROUND
Nitrates have been an integral part of the therapy of ischaemic heart disease for more than 130 years. <


METHODS
We have studied the relevant literature on the benefits of therapy with nitrates in acute myocardial infarction.


CONCLUSIONS
During an acute myocardial infarction, intravenous nitroglycerine therapy has demonstrated favourable haemodynamic properties, and some studies have shown that nitrates reduce infarct size. Whether this could improve prognosis is uncertain. A meta-analysis from 1988 showed reduced mortality (35 %) of early intravenous nitrate therapy. Newer and larger studies have not documented a positive effect. A reason for this discrepancy may be the fact that in these studies about half of the control/placebo patients, having a low mortality, were treated with nitroglycerine. In addition, most of these patients were given thrombolytic and antiplatelet therapy. Nitroglycerine administered intravenously is, according to present knowledge, recommended during the first 24 hours after an acute myocardial infarction. In addition, patients with recurrent ischaemia, uncontrolled hypertension and heart failure should also be given nitroglycerine.
Landmark
Knud
K
Institutt for farmakoterapi, Universitetet i Oslo. k.h.landmark@labmed.uio.no
Reikvam
Asmund
A
D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use*; D014665:Vasodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*
D014665:Vasodilator Agents; D005996:Nitroglycerin