Long-Term Nitrate Treatment Increases Cardiac Events in Patients With Healed Myocardial Infarction

Kinji Ishikawa; Ken Kanamasa; Iwao Ogawa; Toshihiko Takenaka; Takeo Naito; Noriaki Kamata; Tadahiko Yamamoto; Shoji Nakai; Junkichi Hama; Miki Oyaizu; Akio Kimura; Kentaro Yamamoto; Naoko Aso; Miyuki Arai; Hiroshi Yabushita; Ryo Katori; on behalf of the Secondary Prevention Group

doi:10.1253/jcj.60.779

Clinical Study

Long-Term Nitrate Treatment Increases Cardiac Events in Patients With Healed Myocardial Infarction

Kinji Ishikawa, Ken Kanamasa, Iwao Ogawa, Toshihiko Takenaka, Takeo Naito, Noriaki Kamata, Tadahiko Yamamoto, Shoji Nakai, Junkichi Hama, Miki Oyaizu, Akio Kimura, Kentaro Yamamoto, Naoko Aso, Miyuki Arai, Hiroshi Yabushita, Ryo Katori, on behalf of the Secondary Prevention Group

Author information

Kinji Ishikawa
The First Department of Medicine, Kinki University School of Medicine
Ken Kanamasa
The First Department of Medicine, Kinki University School of Medicine
Iwao Ogawa
The First Department of Medicine, Kinki University School of Medicine
Toshihiko Takenaka
The First Department of Medicine, Kinki University School of Medicine
Takeo Naito
The First Department of Medicine, Kinki University School of Medicine
Noriaki Kamata
The First Department of Medicine, Kinki University School of Medicine
Tadahiko Yamamoto
The First Department of Medicine, Kinki University School of Medicine
Shoji Nakai
The First Department of Medicine, Kinki University School of Medicine
Junkichi Hama
The First Department of Medicine, Kinki University School of Medicine
Miki Oyaizu
The First Department of Medicine, Kinki University School of Medicine
Akio Kimura
The First Department of Medicine, Kinki University School of Medicine
Kentaro Yamamoto
The First Department of Medicine, Kinki University School of Medicine
Naoko Aso
The First Department of Medicine, Kinki University School of Medicine
Miyuki Arai
The First Department of Medicine, Kinki University School of Medicine
Hiroshi Yabushita
The First Department of Medicine, Kinki University School of Medicine
Ryo Katori
The First Department of Medicine, Kinki University School of Medicine
on behalf of the Secondary Prevention Group

Keywords: Myocardial infarction, Cardiac events, Sudden death, Secondary prevention, Nitrates

JOURNAL FREE ACCESS

1996 Volume 60 Issue 10 Pages 779-788

DOI https://doi.org/10.1253/jcj.60.779

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Abstract

Background Nitrates dilate coronary arteries, ameliorate myocardial ischemia, minimize left ventricular remodeling, and reduce mortality in patients with acute myocardial infarction. However, the effects of long-term treatment with nitrates on cardiac events in patients with healed myocardial infarction are not known. Methods and Results A total of 1,002 patients with healed myocardial infarction (789 male and 213 female) were randomly divided into 2 groups: treatment with nitrates or nontreatment. The mean observation period was 18.0 ±19.9 months. Primary end points were nonfatal and fatal recurrent myocardial infarction, death from congestive heart failure, and sudden death. Baseline characteristics of the 2 groups were also compared to determine any effects on outcome. Among the 621 cases treated with nitrates, 41 cases (6.6%) experienced cardiac events during the observation period, whereas only 12 of the 381 cases that were not treated with nitrates (3.1%) had cardiac events. This difference was statistically significant (p<0.05; odds ratio 2.17; 95% confidence interval 1.13-4.19). There were no differences in the incidence of noncardiac death or being lost to follow-up between the 2 groups. Although the precise mechanism of this increase in the occurrence of cardiac events by long-term treatment with nitrates is not clear, nitrate tolerance with possible rebound and neurohormonal effects may be involved. Conclusion Long-term treatment with nitrates increased cardiac events in patients with healed myocardial infarction. (Jpn Circ J 1996; 60: 779 - 788)

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