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European Heart Journal 1990 11(2):120-126;
Copyright © 1990 by the European Society of Cardiology.
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© 1990 The European Society of Cardiology

The effects of oral isosorbide 5-mononitrate on mortality following acute myocardial infarction: A multicentre study*

L. J. FITZGERALD and E. D. BENNETT

Department of Medicine, St George's Hospital Medical School London, U.K

Received 24 February 1989; revised 13 June 1989; .

Address for correspondence: Dr Lynn Fitzgerald, Department of Medicine, St George's Hospital Medical School, London SWI7 ORE, U.K.

Abstract

We have conducted a randomized, double-blind, placebo-controlled multicentre trial of oral isosorbide 5-mononitrate (ISMN) in 360 patients with suspected acute myocardial infarction. Patients were stratified prior to analysis according to the presence or absence of left ventricular failure on admission. ISMN caused a significant reduction in systolic and diastolic blood pressure during the first 12 h. There was no significant effect on heart rate.Overall mortality was 4-9% in the ISMN group compared with 40% in controls at 5 days, and 141% compared with 10-5% at 6 months (NS). A non-significant reduction in mortality in the ISMN group with heart failure (ISMN 7-9%, placebo 12-9%, at 5 days) contrasted with a non-significant increase in mortality in patients without heart failure treated with ISMN (ISMN 4-1%, placebo 2-1%, at 5 days). Lignocaine was used in twice as many patients in the ISM N group as in placebo group (P<0-0I), both with and without heart failure. Diamorphine usage was similar in the ISMN and control groups.Oral ISMN has similar haemodynamic effects to intravenous nitroglycerin, and can be of benefit in acute myocardial infarction with heart failure. However, our results question the use of nitrates in acute myocardial infarction in the absence of heart failure

Key Words: Acute myocardial infarction • isosorbide 5-mononitrate


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