{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T07:12:15Z","timestamp":1771485135810,"version":"3.50.1"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Long-acting nitrates are widely prescribed in coronary artery disease (CAD), yet their association with long-term outcomes remains controversial. Whether left ventricular ejection fraction (LVEF) modifies this relationship has not been well characterized.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a single-center retrospective cohort study using the Guizhou Provincial People's Hospital CAD database. Adults (\u226518 years) who underwent coronary angiography between July 2012 and September 2016 and met angiographic criteria for CAD (\u226550% stenosis in \u22651 proximal epicardial coronary artery) were eligible if LVEF and discharge medications were available. Patients were stratified by LVEF (&amp;lt;45%, 45%\u201355%, &amp;gt;55%) and by discharge prescription of any nitrate (mononitrate or dinitrate). The primary endpoint was all-cause death. The secondary endpoint was major adverse cardiovascular events (MACE), defined as a composite of cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Kaplan\u2013Meier methods and multivariable Cox regression were used to evaluate associations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 2,404 patients followed for 27.2\u2009\u00b1\u200913.5 months, 1,153 (48.0%) were discharged on nitrates. In the overall cohort, discharge on nitrates was not associated with all-cause death or MACE. In contrast, among patients with LVEF\u2009&amp;lt;\u200945%, nitrates at discharge were linked to higher cumulative incidences of all-cause death and MACE (log-rank\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u20090.024 and 0.029, respectively) and remained independently associated after adjustment [all-cause death: hazard ratio (HR) 2.14, 95% confidence interval (CI) 1.15\u20133.96; MACE: HR 1.91, 95% CI 1.07\u20133.43]. No significant associations were observed in the LVEF 45%\u201355% or &amp;gt;55% strata.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this CAD cohort, nitrates were commonly prescribed at discharge. An adverse association with long-term outcomes was confined to patients with reduced LVEF, supporting cautious use in this subgroup and highlighting the need for prospective confirmation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fcvm.2026.1662112","type":"journal-article","created":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T06:40:46Z","timestamp":1771483246000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["The effect of nitrates in patients with coronary artery disease across different left ventricular ejection fractions"],"prefix":"10.3389","volume":"13","author":[{"given":"Hui","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Cardiology, Guizhou Provincial People\u2019s Hospital","place":["Guiyang, Guizhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Guizhou Provincial People\u2019s Hospital","place":["Guiyang, Guizhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yalin","family":"Cao","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Guizhou Provincial People\u2019s Hospital","place":["Guiyang, Guizhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zongzhuang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Guizhou Provincial People\u2019s Hospital","place":["Guiyang, Guizhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Piao","family":"Zheng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Zunyi Medical University","place":["Zunyi, Guizhou, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1097\/CRD.0b013e3181c8e14a","article-title":"Nitrates and nitrites in the treatment of ischemic cardiac disease","volume":"18","author":"Nossaman","year":"2010","journal-title":"Cardiol Rev"},{"key":"B2","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1093\/eurheartj\/ehz425","article-title":"2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes","volume":"41","author":"Knuuti","year":"2020","journal-title":"Eur Heart J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"3599","DOI":"10.1093\/eurheartj\/ehab368","article-title":"2021 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure","volume":"42","author":"McDonagh","year":"2021","journal-title":"Eur Heart J"},{"key":"B4","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1253\/jcj.60.779","article-title":"Long-term nitrate treatment increases cardiac events in patients with healed myocardial infarction. 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