What is the role of nitrates in the treatment of NSTE-ACS?
Nitrates are endothelium-independent vasodilators with peripheral and coronary vascular effects. By dilating the capacitance vessels, nitrates decrease cardiac preload and reduce ventricular wall tension. More modest effects on the arterial circulation result in afterload reduction and further decrease in heart rate and contractility. Nitrates also dilate normal and atherosclerotic coronary arteries and increase coronary collateral flow. Nitrates may also inhibit platelet aggregation. Randomized controlled trials (RCTs) have not shown a reduction in major adverse cardiac events (MACE) with nitrates. The decision to administer nitrates should not preclude therapy with other proven mortality-reducing interventions such as beta blockers.