Which patients with coronary artery disease should include oral nitrates on their discharge medication list?

Abstract

Background

Which patients with coronary artery disease (CAD) should have oral nitrates on their discharge medication list after coronary angiography (CAG)? To assess the relationship between oral nitrates included in the discharge medication list and major adverse cardiovascular events (MACEs) among CAD patients, we designed this retrospective cohort study.

Methods

A total of 2979 CAD patients hospitalised in the Department of Cardiology, Affiliated Hospital of Jining Medical University from May 2013 to October 2015 were enrolled, grouped according to whether oral nitrates were included at discharge after CAG, and followed up for MACEs for a mean of 4.42 years after discharge. The primary endpoint was MACEs. Multivariate Cox proportional hazards models were used to analyses potential confounding factors. Stratified analysis was used to observe the relationship between oral nitrates and MACEs by different covariates.

Results

The median follow-up time was 4.61 years, and 296 (9.94%) patients experienced MACEs. Multivariate Cox proportional hazards model analysis showed no association between oral nitrates on the discharge medication list and the occurrence of MACEs among patients with CAD (p > 0.05) after adjusting for some covariates, such as SYNTAX score (hazard ratio (HR): 1.18, 95% confidence interval (CI): 0.90–1.55, p = 0.2420). Stratified analysis revealed a higher incidence of MACEs among hypertensive patients prescribed oral nitrates at discharge (HR: 1.67, 95% confidence CI: 1.13–2.46, p = 0.0046). However, prescribing nitrates at discharge for patients with low uric acid levels increased the incidence of MACEs, which showed a possible trend towards significance (HR: 1.44, 95% CI: 0.99–2.09, p = 0.0525)

Conclusion

There was no association between oral nitrates included in the discharge medication list and the development of MACEs among patients with CAD after adjusting for some covariates, such as SYNTAX score. Oral nitrates after discharge for CAD patients combined with hypertension increased the occurrence of MACEs. Oral nitrates after discharge for CAD patients combined with low uric acid levels may increase theoccurrence of MACEs, and close monitoring for any adverse events is recommended.

Keywords:

• Nitrates
• coronary artery disease
• major adverse cardiovascular events

Acknowledgement

The authors thank all the staff members in our institution.

Ethics approval and consent to participate

Participants informed consent is not required in this study because of the nature of retrospective cohort study. The study was approved by the ethics committee of Affiliated Hospital of Jining Medical University. The data are anonymous, and the requirement for informed consent was therefore waived.

Authors’ contributions

Chen Xueying and Zhang Hua performed the conception design, analysis the data and the drafting of the manuscript. Zhang Shaohui and Gan Lijun designed the study and revised the manuscript. All authors participated in the data collection and the final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Availability of data and materials

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Additional information

Funding

This work was supported by China Postdoctoral Science Foundation [71th Batch-2022M711321], Provincial Natural Science Foundation [ZR2017LH001], Shandong Province Key Project of TCM science and technology [Z-2022081], Key research and development plan in Jining City [2022YXNS003], Jining Medical University Research Fund for Academician Lin He New Medicine [JYHL2022FZD03].