Spotlight on Research

Current guidelines recommend that when right ventricular myocardial infarction (RVMI) is present, nitrates should not be administered. The advice is predicated upon the risk that decreasing preload in an already compromised right ventricular ejection fraction may further reduce cardiac output and cause hypotension; however, question marks hang over the quality of evidence that informed this recommendation. New studies have been published in this domain—so it is time to revisit the topic.

The authors undertook a systematic review to answer the question ‘Is nitrate administration to patients with RVMI associated with increased adverse events compared with nitrate administration to patients with myocardial infarctions only in other regions?’ Six databases were systematically searched in May 2022 and two investigators independently assessed for quality and bias and extracted data in accordance with the Joanna Briggs Institute tools and methods. Risk ratios and 95% confidence intervals (CI) were calculated, and meta-analysis performed on two studies (others lacked the rigour for meta-analysis).