Influence of long-acting nitrate therapy on the risk of reinfarction, sudden death, and total mortality in survivors of acute myocardial infarction.

The effects of 20 variables that might influence postmyocardial infarction prognosis were assessed retrospectively in 139 patients followed up for an average of 11 months after discharge from San Francisco General Hospital following an acute myocardial infarction. When these variables were analyzed with the use of multivariate techniques, the presence of complex ventricular ectopy was the variable most highly predictive of the mortality rate, followed by age and failure to receive long-acting nitrates, principally isosorbide dinitrate (ISDN). Whereas 23 of 90 patients (25.6%) not receiving ISDN died, only 5 of the 49 patients (10%) receiving ISDN died (p less than 0.05). Although total mortality was statistically significantly greater among patients receiving antiarrhythmic drugs or digitalis than among patients not receiving these agents, these relationships did not persist when subjected to multivariate analysis.