Chest pain relief by nitroglycerin does not predict active coronary artery disease

Ann Intern Med. 2003 Dec 16;139(12):979-86. doi: 10.7326/0003-4819-139-12-200312160-00007.


Background: The belief that chest pain relief with nitroglycerin indicates the presence of active coronary artery disease is common. However, this hypothesis has not been tested.

Objective: To define the diagnostic and prognostic value of chest pain relief with nitroglycerin.

Design: Prospective observational cohort study.

Setting: Urban community teaching hospital.

Patients: 459 consecutive patients with chest pain admitted through the emergency department who received nitroglycerin from emergency services personnel or an emergency department nurse. Follow-up was obtained by telephone contact at 4 months.

Measurements: Chest pain relief was defined as a decrease of at least 50% in patients' self-reported pain within 5 minutes of the initial dose of sublingual or spray nitroglycerin. Active coronary artery disease was defined as any elevated serum enzyme levels, coronary angiography demonstrating a 70% or greater stenosis, or a positive exercise test result.

Results: Nitroglycerin relieved chest pain in 39% of patients (181 of 459). In patients with active coronary artery disease as the likely cause of their chest pain, 35% (49 of 141) had chest pain relief with nitroglycerin. In contrast, in patients without active coronary artery disease, 41% (113 of 275) had chest pain relief (P > 0.2). Four-month clinical outcomes were similar in patients with or without chest pain relief with nitroglycerin (P > 0.2).

Conclusions: These data suggest that, in a general population admitted for chest pain, relief of pain after nitroglycerin treatment does not predict active coronary artery disease and should not be used to guide diagnosis.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Algorithms
  • Chest Pain / drug therapy*
  • Chest Pain / etiology
  • Coronary Disease / complications
  • Coronary Disease / diagnosis*
  • Emergency Service, Hospital
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Maryland
  • Middle Aged
  • Nitroglycerin / therapeutic use*
  • Prognosis
  • Prospective Studies
  • Sensitivity and Specificity
  • Vasodilator Agents / therapeutic use*


  • Vasodilator Agents
  • Nitroglycerin