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Acute coronary syndrome (ACS) is a life threatening conditions due to decreased blood flow in coronary arteries. Nitrate is one of main drugs used in the management of ACS. However, the situation of nitrate clinical application in China is not fully understood. This is a multicenter, retrospective, cross-sectional survey, which for the first time understanding the current status of clinical use of nitrates in the patients with ACS in China, provide data and support for further standardizing clinical practice, and propose executable suggestions and opinions for standardized application of nitrates in ACS treatment.
The information of the patients hospitalized with the diagnosis of ACS who received nitrate treatment from May 1st to Nov 15th in 2014 was collected by standardized questionnaire sent to every center enrolled in the survey. The questionnaire included patients' demography, clinical characteristics, nitrate treatment information and so on.
800 questionnaires were collected from 19 hospitals, among which 794 records accorded with the inclusion criteria and were fit into final analysis. Among the 794 patients with ACS, 310 patients(42.23%) received continuously nitrates treatment intravenously, 464 patients (58.44%) were treated by oral medication of nitrates discontinuously, 356 patients (44.84%) received intravenous nitrates treatment discontinuously. Among the 310 ACS patients with received intravenous nitrates treatment continuously, treatments were suspended in 178 patients(57.41%) within 48 hours, owing to syndrome remission, hypotension, headache and others, and were continued in 130 patients(41.94%)after 48 hours, owing to cardiac insufficiency, continuous existence of ischemic symptoms and others. After discharged from hospital, a total of 408 patients with ACS continued nitrates treatment, among which 19 (4.66%) patients took isosorbide dinitrate, 385 (94.36%) patients took isosorbide monodinitrate and both drugs were taken by 4 (0.98%) patients. However, there were 65 patients with contraindication of nitrate were treated with nitrate, such as 21 patients with acute inferior wall myocardial infarctiona with right ventricular infarct (1 dead), 9 patients with systolic pressure < 90 mmHg (0 dead), 11 and 24 patients with heart rate <50 and >110 beats/min (1 and 1 dead), respectively. Moreover, the mean starting doses of nitroglycerin (22.08±13.75 μg/min) and isosorbide dinitrate (61.09±103.85 μg/min) were far more from the standard. 303 patients received complete revascularization, among them 211 (69.64%) patients were still using nitrates after complete revascularization.
In general, the clinical use of nitrates in ACS patients treatment in China is firstly reviewed and analyzed in this multicenter survey. Nevertheless, there is still problems in the application of nitrates in ACS for now.