A topic in Clinical Evidence 1 summarizes the evidence on nitrates in acute myocardial infarction. RCTs performed before and during the thrombolytic era have found that nitrates are safe in the acute management of symptoms in patients with AMI. A beneficial effect on mortality was seen only in studies without thrombolysis (RRR 35%, 95% CI 16% to 55%), but the benefit on long-term survival was modest. In two large RCTs that compared nitrates given acutely versus placebo in 58,050 and 17,817 patients with AMI, there was no significant improvement in survival, either in the total sample or in subgroups of people at different risks of death.
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