Patients with "chest pain" account for approximately 20% of all hospital admissions. For many years, it has been widely accepted that relieving chest pain with nitroglycerin is a diagnostic criterion for coronary artery disease (CHD). Many clinical guidelines state that stopping chest pain with nitroglycerin has important diagnostic value. However, there are a significant number of conditions accompanied by chest pain, and only a small number of these patients suffer from angina or acute coronary syndrome. Many of these conditions may respond to taking nitroglycerin, for example, pain during spasm of the esophagus, etc.

Dr. Charles Henrikson and colleagues from Johns Hopkins University, Baltimore, USA, have conducted a prospective observational study to find out if stopping chest pain with nitroglycerin is a reliable diagnostic criterion for coronary artery disease..

The study included patients regularly admitted to the admissions department of the Johns Hopkins Medical Center with complaints of chest pain. Nitroglycerin was taken at a dose of 0.4 mg sublingually in the form of tablets or spray under the supervision of the service's medical personnel or the visiting team. Pain was rated on a 10-point scale immediately before and 5 minutes after taking nitroglycerin. During a pain attack, an ECG was performed.

Chest pain was considered to "respond to nitroglycerin" if the pain intensity decreased by at least 50% after taking the first dose of nitroglycerin.

The study included 459 patients. In 39% (181 patients), the pain was stopped by taking nitroglycerin, in 61% (278 patients) it was not stopped.

The study gathered more detailed patient information to determine if an exacerbation of coronary artery disease was the cause of chest pain.

The corresponding symptoms were considered to be the criteria for exacerbation of coronary artery disease in combination with at least one of the following indicators: elevation of serum troponin T, coronary artery stenosis of 70% or more according to angiography, test positive stress, diagnosis of exacerbation of coronary heart disease, established by the attending physician during hospitalization.

In 31% (141) of the patients, the cause of chest pain was an exacerbation of coronary artery disease, 60% (275) of the patients did not have an exacerbation of coronary artery disease. In 9% (43) patients, for various reasons, it was not possible to determine the cause of the pain.

In the group of patients whose pain was caused by an exacerbation of coronary artery disease, only in 35% (49/141) of cases, the pain was stopped by nitroglycerin. In contrast, in the group of patients without exacerbation of coronary artery disease, the pain was stopped by nitroglycerin in 41% (113/275) of the cases.

Thus, the sensitivity of the test to the diagnosis of coronary heart disease was only 35%, the specificity - 59%.

On the ECG performed during a pain attack, there was no significant difference between the groups of patients who responded and did not respond to nitroglycerin (p greater than 0.2). In addition, there was no statistically significant difference between these groups in terms of mortality, subsequent development of myocardial infarction, coronary revascularization.

The results of the study showed the absence of diagnostic and prognostic significance of stopping chest pain with nitroglycerin and showed that this test should not be taken into account when choosing treatment tactics in the environment. hospital.

The data from this study refute the widely held belief that nitroglycerin is an important treatment for pain in the diagnosis of coronary artery disease. However, it should be borne in mind that only emergency hospital patients were included in the study, and the results of the study cannot be unambiguously extrapolated to ambulatory conditions. The causes of chest pain in patients undergoing hospital and outpatient treatment are numerous, as are the mechanisms of myocardial ischemia. Therefore, a positive response to nitroglycerin is always an important diagnostic feature in outpatient practice, at least until further studies are carried out.