The Role of nitroglycerin in Acute Myocardial Infarction

Since Murrell’s initial description in 1879, sublingual nitroglycerin has been the cornerstone of therapy for angina pectoris [1]. Long-acting oral forms of nitroglycerin and cutaneous nitroglycerin ointment have been used prophy-lactically to prevent anginal attacks for more than 25 years. As recently as 1966, Friedberg’s Textbook of Cardiology warned that nitroglycerin was con-traindicated in patients with acute myocardial infarction [2]. Using careful electrocardiographic and blood-pressure monitoring, cardiologists at The Johns Hopkins Hospital began studying the short-term hemodynamic and antiischemic effects of intravenous nitroglycerin in patients with acute myocardial infarction more than 15 years ago [3-6]. We have also completed a randomized placebo-controlled trial of 48-hour infusion of intravenous nitroglycerin in patients with acute infarction. The endpoints of this longer term study were “infarct size” and clinical outcome [7].