A Cochrane review [Abstract] 1 on effect of early treatment with ACE inhibitors (12 studies), beta-blockers (20), calcium channel blockers (CCBs) (18) and nitrates (18 studies, n=84 413) on short and long-term mortality in patients with an acute cardiovascular event included 65 studies with a total of 166 206 subjects. Immediate nitrate treatment (started within 24 hours of the onset and lasting for maximum 2 days) reduced all-cause mortality during the first 2 days (RR 0.81, 95% CI 0.74 to 0.89; 6 studies, n=82 624), but not at day 10 (RR 0.84, 95% CI 0.69 to 1.01, I2=63%; 10 studies, n=6 007) or at ≥30 days (during a weighted average of 12 months of follow-up)(RR 0.92, 95% CI 0.82 to 1.04; 7 studies, n=5 771) in patients with acute myocardial infarction. Short-term treatment (started within 24 hours of the onset and lasting for a maximum of 10 days) with nitrates was associated with a statistically significant reduction in all-cause mortality (RR 0.91, 95% CI 0.86 to 0.97; 6 studies, n=78 178) at day 10, but not at ≥ 30 days (during a weighted average of 4 months of follow-up)(RR 0.72, 95% CI 0.48 to 1.10, I2=81%; 3 studies, n=570).
Comment: The quality of evidence is downgraded by study quality (lack of blinding).
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