Organic nitrates in acute coronary syndrome

Abstract

Large randomized trials have shown that routinely applied nitrates (iv or orally), in acute coronary syndrome (ACS) do not reduce significantly mortality. Nevertheless, nitrates still have a place in therapy of certain patients with ACS and they are effective in alleviating ischemia. Nitroglycerin is indicated for the relief of persistent pain and as vasodilator in patients with acute myocardial infarction associated with left ventricular failure. However, in the absence of recurrent angina or congestive heart failure, we do not routinely prescribe them for patients with ACS. Patients with large transmural infarction particularly of the anterior wall, have the most to gain from nitrates in the light of reduction of ventricular remodeling. In such patients nitrates are given as intravenous infusion routinely for 24 to 48 hours. Nitrates should not prescribed beyond the first 48 hours, unless angina or ventricular failure is present.

U velikim kliničkim studijama pokazano je da rutinska primena nitroglicerina (iv ili oralno) u akutnom koronarnom sindromu (AKS) ne smanjuje značajno mortalitet. Međutim, nitrati i dalje imaju svoje mesto u terapiji posebnih grupa bolesnika sa AKS i uspešno se primenjuju za ublažavanje ishemije. Nitroglicerin se primenjuje za otklanjanje perzistentnog bola i kao vazodilatator u pacijenata sa akutnim infarktom miokarda (AIM) i slabošću levog srca. Ukoliko, međutim, pacijent nema rekurentni ishemijski bol ili kongestivnu srčanu slabost, nitrati se ne primenjuju rutinski u pacijenata sa AKS. Pacijenti sa velikim transmuralnim infarktom posebno prednjeg zida imaju najviše koristi od primene nitrata u svetlu smanjenja remodelovanja komora. U takvih pacijenata se primenjuju nitrati u obliku intravenske infuzije rutinski tokom 24 do 48 sati. Treba nastaviti davanje nitrata duže od 48 sati bolesnicima koji imaju rekurentnu ishemiju ili slabost srca.