Improved compliance with therapy is a strong rationale for timing the initiation of lipid-lowering drug therapy before discharge after STEMI. Longer-term lipid management after STEMI, including indications for targeting triglycerides and non high-density lipoprotein cholesterol, are addressed in the O Gara et al 2013 ACCF/AHA STEMI Guideline e391 AHA/ACC Secondary Prevention and Risk Reduction Ther- apy for Patients With Coronary and Other Vascular Disease: Although nitroglycerin can ameliorate symptoms and signs of myocardial ischemia by reducing LV preload and increas- ing coronary blood flow, it generally does not attenuate the myocardial injury associated with epicardial coronary artery occlusion unless vasospasm plays a significant role. Intrave- nous nitroglycerin may be useful to treat patients with STEMI and hypertension or HF. Nitrates should not be given to patients with hypotension, marked bradycardia or tachycardia, RV infarction, or 5'phosphodiesterase inhibitor use within the There is no role for the routine use of oral nitrates in the convalescent phase of STEMI. 8.5. Calcium Channel Blockers An overview of 28 RCTs involving 19000 patients demon- strated no beneficial effect on infarct size or the rate of rein- farction when calcium channel blocker therapy was initiated during either the acute or convalescent phase of STEMI.445 Calcium channel blockers may be useful, however, to relieve ischemia, lower BP, or control the ventricular response rate to atrial fibrillation (AF) in patients who are intolerant of beta blockers. Caution is advised in patients with LV systolic dys- function. The use of the immediate-release nifedipine is con- traindicated in patients with STEMI because of hypotension and reflex sympathetic activation with tachycardia.446 Few data exist to support or refute the value of the routine use of oxygen in the acute phase of STEMI, and more research is needed. 