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Nitroglycerine ‘unreliable’ for detecting angina

Nitroglycerine is not a reliable test for the diagnosis of coronary artery disease and it should not be used to triage patients, a systematic review has found.

The analysis looked at five papers – four cohort studies and one retrospective review – and in total included 1,978 patients that presented to their emergency department with a complaint of chest pain and admitted with an uncertain diagnosis.

They found that sublingual nitroglycerine as a test in the diagnosis of coronary heart disease was ‘uninformative' and its use should be discouraged.

The combined sensitivity across all five studies was 0.52 for the test, with a combined specificity of 0.49. The authors concluded that the accuracy of using nitroglycerine as a ‘test of treatment' for diagnosis was poor.

The authors admitted the study findings could not be generalised to patients with chest pain in primary care, but said there was little evidence to support its use.

Study lead Dr Katherine Grailey of Oxford University said: ‘This review confirms that nitroglycerine is an unreliable diagnostic tool for patients presenting with chest pain of uncertain aetiology, nor is useful as a triage tool in the emergency room. If it is administered for pain relief, the response should not be taken as an indicator of a coronary cause.'

‘Practitioners and guidelines should warn against the use of nitroglycerine as a test.'

 

Emergency Medical Journal 2012

http://emj.bmj.com/content/29/3/173.long

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