Article Text

  1. M. L. McConahy,
  2. J. K. Lam,
  3. R. Steele
  1. Loma Linda, CA.


Introduction It is commonly believed that chest pain relieved by taking nitroglycerin (NTG) is caused by active coronary artery disease (CAD). Is this medical myth or is this true?

Objective To determine if the relief of chest pain by NTG has diagnostic value.

Design Prospective observational cohort study.

Setting Academic Tertiary hospital with approximately 60,000 visits per year.

Inclusion Criteria Patients presenting to the emergency department (ED) with chest pain who received NTG from emergency personnel or an ED nurse. Follow-up was obtained by telephone contact at 2-4 weeks.

Exclusion Criteria Patients that presented with an EKG showing signs of an acute MI and patients that went to the cardiac catheterization lab emergently.

Outcome Variables Chest pain relief was defined as a decrease in chest pain by at least 50% within 10 minutes of receiving a dose of sublingual or spray NTG. Active CAD was defined as an elevated Troponin I level, coronary angiography with a stenosis ≥ 70%, or a positive provocative cardiac test (treadmill, cardiolyte, dobutamine stress, etc.) during the admission for chest pain.

Results Eighty-one patients were enrolled. NTG relieved chest pain in 65% of patients (53/81). Of the patients with active CAD as the likely cause of their chest pain, 72% (18/25) had chest pain relief with NTG. Chest pain relief occurred 63% (35/56) of the time in patients without CAD. Sensitivity was 72%. Specificity was 38%. The likelihood ratio was 1.1.

Conclusions In ED chest pain patients, relief of chest pain with NTG does not alter the pretest probability that the chest pain is secondary to active CAD. NTG should not be used to determine if chest pain is related to CAD.

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