Analysis of the use of nitroglycerin in pre-hospital procedure by medical rescue teams in patients with acute coronary syndrome (ACS STEMI), with particular regard to a closed right coronary artery

Grzegorz Wójcik, Maciej Lewandowski, Marek Myślak, Paulina Wójcik, Magdalena Bikowska


Introduction: Currently, cardiological societies and associations do not recommend the use of nitroglycerin in patients with acute coronary syndrome ST-elevation myocardial infarction (ACS STEMI). However, an analysis of medical rescue practice shows that this medicine is still being used.
The aim of this study is to conduct a correlation analysis of the use of nitroglycerin by medical rescue teams (MRT) in patients with ACS STEMI and its impact on selected biochemical parameters.
Materials and methods: The study group consisted of 312 patients. Data for these patients over a period of 8 years (2009–2017) was analysed. A retrospective study of the dispatch orders for MRT, including primary transport was conducted.
Results: Coronary angiography revealed a closed right coronary artery (RCA) in 312 patients. In 210 patients, the MRT administered nitroglycerin during pre-hospital procedure, where RCA closure was confirmed in a coronary angiography. After administering nitroglycerin and discovering an RCA occlusion, more favourable results of biochemical parameters and statistical differences between the groups in Killip class were shown (p = 0.022). Lower values of Troponin I and creatine kinase–myocardial band (CK-MB) max. parameters as well as higher cardiac ejection fraction (left ventricular ejection fraction – LVEF) were observed after administering nitroglycerin (no statistical significance).
Conclusions: It was not clearly demonstrated that the use or non-use of nitroglycerin at the pre-hospital stage (1–2 doses of the drug) negatively affected the patient’s condition. At the same time, it was shown that the use of nitroglycerin at the pre-hospital stage, and the lack of nitroglycerin administration at hospital resulted in lower, selected biochemical parameters, and that theuse of nitroglycerin had a significant impact on the Killip class.


acute coronary syndrome; emergency medicine; nitroglycerin; right ventricular heart failure

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