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ORIGINAL RESEARCH article

Front. Neurol.

Sec. Stroke

Volume 16 - 2025 | doi: 10.3389/fneur.2025.1577700

This article is part of the Research TopicRedefining Stroke Recovery: Current Trends and Recent AdvancesView all 5 articles

Impact of Nitroglycerin on 28-Day Mortality in Ischemic Stroke Patients: A Retrospective Cohort Study Using the MIMIC-IV Database

Provisionally accepted
  • 1Heilongjiang University of Chinese Medicine, Harbin, China
  • 2The Second Hospital Affiliated to Heilongjiang University of Traditional Chinese Medicine, Harbin, Jilin Province, China

The final, formatted version of the article will be published soon.

Background: The impact of nitroglycerin (NTG) on short-term outcomes in ischemic stroke patients remains unclear. This study aimed to evaluate the association between NTG use—including route, timing, and duration—and 28-day in-hospital mortality. Methods: We conducted a retrospective cohort study of 3,434 ischemic stroke patients, including 356 who received NTG. Propensity score matching (1:1) was used to reduce confounding. Cox proportional hazards models, Kaplan–Meier analysis, and stratified analyses assessed the association between NTG use and mortality. Results: NTG use was associated with reduced 28-day mortality before (HR = 0.52, P < 0.001) and after matching (HR = 0.50, P = 0.003). Kaplan–Meier curves confirmed this benefit. Among administration routes, only intravenous drip (IV) was significantly associated with reduced mortality (P < 0.001). Early initiation within 24 hours (P < 0.001) and a treatment duration of 1–3 days (P < 0.001) were also significantly associated with lower mortality. No benefit was observed for other routes, delayed initiation, or longer durations. Dose-stratified analysis showed no difference between low and high doses (P = 0.59). Conclusions: IV NTG, started within 24 hours and continued for 1–3 days, was significantly associated with lower 28-day mortality in ischemic stroke patients. These findings suggest a potential therapeutic window and warrant further prospective validation.

Keywords: Nitroglycerin, ischemic stroke, Mortality, MIMIC-IV database, Therapeutic potential

Received: 16 Feb 2025; Accepted: 30 Aug 2025.

Copyright: © 2025 Zuo, Zuo and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence:
Huan Zuo, Heilongjiang University of Chinese Medicine, Harbin, China
Linjing Wang, The Second Hospital Affiliated to Heilongjiang University of Traditional Chinese Medicine, Harbin, Jilin Province, China

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