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Chronic nitrate therapy is associated with different presentation and evolution of acute coronary syndromes: insights from 52,693 patients in the Global Registry of Acute Coronary Events
Authors
Ambrosio, GiuseppeDel Pinto, Maurizio
Tritto, Isabella
Agnelli, Giancarlo
Bentivoglio, Maurizio
Zuchi, Cinzia
Anderson, Frederick A. Jr.
Gore, Joel M.
Lopez-Sendon, Jose
Wyman, Allison
Kennelly, Brian M.
Fox, Keith A. A.
UMass Chan Affiliations
Department of Medicine, Division of Cardiovascular MedicineCenter for Outcomes Research
Document Type
Journal ArticlePublication Date
2010-02-12Keywords
Acute Coronary SyndromeAdolescent
Adult
Aged
Cardiotonic Agents
Female
Hospital Mortality
Humans
Ischemic Preconditioning, Myocardial
Male
Middle Aged
Muscle Cells
Myocardial Infarction
Necrosis
Nitrates
Prospective Studies
Treatment Outcome
Young Adult
Health Services Research
Metadata
Show full item recordAbstract
AIMS: Brief episode(s) of ischaemia may increase cardiac tolerance to a subsequent major ischaemic insult ('preconditioning'). Nitrates can pharmacologically mimic ischaemic preconditioning in animals. In this study, we investigated whether antecedent nitrate therapy affords protection toward acute ischaemic events using data from the Global Registry of Acute Coronary Events. METHODS AND RESULTS: The dataset comprised 52,693 patients from 123 centres in 14 countries: 42,138 (80%) were nitrate-naive and 10,555 (20%) were on chronic nitrates at admission. In nitrate-naive patients, admission diagnosis was ST-segment elevation myocardial infarction (STEMI) in 41%, whereas 59% presented with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). In contrast, only 18% nitrate users showed STEMI, whereas 82% presented with NSTE-ACS. Thus, among nitrate users clinical presentation was tilted toward NSTE-ACS by more than four-fold, STEMI occurring in less than one of five patients (P < 0.0001). After adjustment (age, sex, medical history, prior therapy, revascularization, previous angina), chronic nitrate use remained independent predictor of NSTE-ACS (OR 1.36; 95% CI 1.26-1.46; P < 0.0001). Furthermore, regardless of presentation, within both STEMI and NSTEMI populations, antecedent nitrate use was associated with significantly lower levels of CK-MB and troponin (P < 0.0001 for all). CONCLUSION: In this large multinational registry, chronic nitrate use was associated with a shift away from STEMI in favour of NSTE-ACS and with less release of markers of cardiac necrosis. These findings suggest that in nitrate users acute coronary events may develop to a smaller extent. Randomized, placebo-controlled trials are warranted to establish whether nitrate therapy may pharmacologically precondition the heart toward ischaemic episodes.Source
Eur Heart J. 2010 Feb;31(4):430-8. Epub 2009 Nov 10. Link to article on publisher's siteDOI
10.1093/eurheartj/ehp457Permanent Link to this Item
http://hdl.handle.net/20.500.14038/27198PubMed ID
19903682Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1093/eurheartj/ehp457