Nitroglycerine use preceding PCI for ACS tied to lower BP and adverse clinical outcomes in elderly
Primary care for acute coronary syndrome (ACS) typically involves administering nitroglycerin (GTN). However, it remains unclear whether GTN use before primary percutaneous coronary intervention (PCI) is related to major adverse cardiovascular events (MACE) in the era of changing patient characteristics and advancements in ACS management, which include advances in PCI and optimal medical therapy.
According to a recent study published in BMJ Open Heart Journal, the use of GTN preceding primary PCI for ACS was found to have an independent association with the incidence of MACE within one year. Additionally, the GTN group had a significantly higher incidence of MACE in comparison to the non-GTN group in elderly patients who are aged ≥75 years.
This study analyzed the relationship between administering nitroglycerin (GTN) before percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS) and clinical outcomes. The researchers examined 947 ACS patients who underwent PCI and divided them into two groups: those who received GTN before PCI (GTN group) and those who did not (non-GTN group). They compared the rates of major adverse cardiovascular events (MACE), including all-cause mortality, non-fatal myocardial infarction, stroke, and rehospitalization for heart failure, between the two groups at one year.
Key findings from the study are:
· The study had 289 patients with ACS who used GTN preceding PCI.
· In the GTN group, Pre-PCI systolic blood pressure was lower than in the non-GTN group.
· GTN use preceding PCI demonstrated an independent association with the MACE incidence with HR 1.57.
· MACE incidence one year after PCI for ACS was higher in the GTN group compared to the non-GTN group. This trend was consistently found in elderly patients aged ≥75 but not in non-elderly patients aged <75.
In conclusion, they said Elderly people who underwent angioplasty for acute coronary syndrome fared poorly if they had received preprocedural nitroglycerine.
Study limitations include a single-centre cohort, potential undetermined cofounders influencing present results, and failure to show data on the onset of chest symptoms to GTN use.
Reference:
Komaki S, Matsuura Y, Tanaka H, et al. Nitroglycerin use and adverse clinical outcomes in elderly patients with acute coronary syndrome. Open Heart 2024;11:e002494. doi: 10.1136/openhrt-2023-002494
