title: Long-term nitrate therapy after acute myocardial infarction does not improve or aggravate prognosis.
abstract: BACKGROUND
  There is conflicting information about whether nitrate treatment aggravates long-term prognosis, so the present retrospective study was designed to determine the effects of long-term nitrate therapy on major adverse events after acute myocardial infarction (AMI) in the coronary interventional era.
  
  
  RESULTS
  Using the Japanese Acute Coronary Syndrome Study database, 1,236 consecutive patients who were hospitalized within 48 h of onset of symptoms of AMI from January to December 2003 were evaluated. All-cause mortality, cardiac events and cardiovascular events were lower in patients treated with nitrates than in the untreated controls. However, these crude comparisons included several confounding factors on nitrate prescription. To minimize the effect of selection bias on outcomes, the technique of propensity score matching for clinical characteristics was used and distortion of effective nitrate treatment was excluded as much as possible. The results of propensity score matching showed that nitrate therapy had no impact on all-cause mortality, cardiac events and cardiovascular events at 30, 60 or 90 days, 6 months, 1 year, and 2 years follow-up.
  
  
  CONCLUSIONS
  Long-term nitrate therapy after AMI neither improves nor aggravates prognosis. Prospective randomized clinical trials are warranted to determine the effects of long-term nitrate therapy for secondary prevention of AMI.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. kojimas@kumamoto-u.ac.jp
authors.forename: Sunao
authors.initials: S
authors.lastname: Kojima
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Matsui
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Sakamoto
authors.forename: Masaharu
authors.initials: M
authors.lastname: Ishihara
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.forename: Shunichi
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Masakazu
authors.initials: M
authors.lastname: Yamagishi
authors.forename: Chuwa
authors.initials: C
authors.lastname: Tei
authors.forename: Hisatoyo
authors.initials: H
authors.lastname: Hiraoka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Sonoda
authors.forename: Kazufumi
authors.initials: K
authors.lastname: Tsuchihashi
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shimoyama
authors.forename: Takashi
authors.initials: T
authors.lastname: Honda
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ogata
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D009566:Nitrates / Q000627:therapeutic use*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D009566:Nitrates