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Letters |17 August 2004

Chest Pain Relief by Nitroglycerin

Arthur T. Evans, MD, MPH; Brendan M. Reilly, MD

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  • From Cook County Hospital and Rush Medical College, Chicago, IL 60612.
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TO THE EDITOR:
Henrikson and colleagues (1) concluded that pain relief by nitroglycerin did not predict disease in 459 patients admitted to the hospital for work-up of possible ischemic heart disease. Many study participants with missing or uninterpretable test results were dropped from the analysis, an important type of selection bias that can be measured (and eliminated) when calculating likelihood ratios (2). In addition, the study involved a highly select subgroup—patients with rest pain occurring during evaluation—rather than all patients presenting with chest pain. However, the most serious threat to the validity and generalizability of Henrikson and colleagues' findings is work-up bias.
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Evans AT, Reilly BM. Chest Pain Relief by Nitroglycerin. Ann Intern Med. ;141:324. doi: 10.7326/0003-4819-141-4-200408170-00021

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Published: Ann Intern Med. 2004;141(4):324.

DOI: 10.7326/0003-4819-141-4-200408170-00021

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2004 American College of Physicians
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704

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