Abstract
Background
Although antianginal drugs are used over several months and through to years in stable angina, there is scant evidence regarding their influence on outcomes. The METRO (ManagEment of angina: a reTRospective cOhort) study sought to assess the independent effect of using these drugs on subsequent mortality risk in patients with stable angina.
Methods
Consecutive patients with stable angina, receiving at least one antianginal drug (nitrates, β-adrenoceptor antagonists, calcium channel antagonists, trimetazidine, or nicorandil), were selected if they were discharged alive from an intensive care unit following a myocardial infarction (MI). Their case-record data were used in a multivariate logistic regression model to examine the independent association of antianginal drug use prior to the MI with predicted post-discharge, 6-month, all-cause mortality risk.
Results
In 353 patients, of whom 287 (81.3%) were men, the mean (±SD) age was 55 (±10.2) years and duration of treated stable angina was 27.2 (±24.8) months. The odds ratios (95% CI) of 6-month, all-cause mortality after surviving an MI were: for treatment that included a β-adrenoceptor antagonist, 0.63 (0.26, 1.52; p = 0.309); a calcium channel antagonist, 0.76 (0.12, 2.89; p = 0.638); a nitrate, 0.52 (0.26, 1.05; p = 0.070); nicorandil, 0.62 (0.29, 1.33; p = 0.221); and trimetazidine, 0.36 (0.15, 0.86; p = 0.022).
Conclusion
The inclusion of trimetazidine in the antianginal treatment of stable angina is independently associated with a significant reduction in mortality after surviving an MI. This suggests that combining a metabolic agent with drugs that modulate oxygen supply and demand, early in the management of stable angina, may confer a survival benefit.
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References
Abrams J. Chronic stable angina. N Engl J Med 2005; 352: 2524–33.
Pfeffer MA, McMurray JJV, Veazquez EJ, et al. Valsartan, captopril, or both in myocardial infarction complicated by heart failure: left ventricular dysfunction or both. N Engl J Med 2003; 349: 1893–906.
Opie LH. The metabolic vicious cycle in heart failure. Lancet 2004; 364: 1733–4.
Kowalczyk E, Kopff M, Kowalski J, et al. Effect of cardiovascular drugs on adenosine deaminase activity. Angiology 2008; 59: 740–4.
Poole-Wilson P, Lubsen J, Kirwan B, et al. Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION trial) randomised controlled trial. Lancet 2004; 364: 849–57.
The IONA Study Group. Effect of nicorandil on coronary events in patients with stable angina: the Impact of Nicorandil in Angina (IONA) randomised trial. Lancet 2002; 359: 1269–75.
Heidenreich PA, McDonald KM, Hastie T, et al. Meta-analysis of trials comparing b-blockers, calcium antagonists, and nitrates for stable angina. JAMA 1999; 281: 1927–36.
Eagle KA, Lim MJ, Dabbous OH, et al. A validated prediction model for all forms of acute coronary syndrome: estimating the risk of 6-month post-discharge death in an international registry. JAMA 2004; 291: 2727–33.
Psaty BM, Furberg CD. Contemplating ACTION: long acting nifedipine in stable angina. Lancet 2004; 364: 817–8.
Banach M, Rysz J, Goch A, et al. The role of trimetazidine after acute myocardial infarction. Curr Vasc Pharmacol 2008; 6: 282–91.
Marzilli M, Focardi M, Affinito S, et al. The rationale of metabolic treatment in ischaemic heart disease. Arch Med Sci 2007; 3: S25–9.
Caminiti G, Marazzi G, Vitale C, et al. Metabolic management of diabetic patients with ischaemic heart disease. Arch Med Sci 2007; 3: S30–7.
El-Kady T, El-Sabban K, Gabali M, et al. Effects of trimetazidine on myocardial perfusion and the contractile response of chronically dysfunctional myocardium in ischemic cardiomyopathy. Am J Cardiovasc Drugs 2006; 5: 271–8.
Di Napoli P, Taccardi AA, Barsotti A. Long term cardioprotective action of trimetazidine and potential effect on the inflammatory process in patients with ischaemic dilated cardiomyopathy. Heart 2005; 91: 161–5.
Fragasso G, Perseghin G, De Cobell F, et al. Effects of metabolic modulation by trimetazidine on left ventricular function and phosphocreatinine/adenosine triphosphate ratio in patients with heart failure. Eur Heart J 2006; 27: 942–8.
Beardinelli R, Purcaro A. Effects of trimetazidine on the contractile response of chronically dysfunctional myocardium to low dose dobutamine in ischemic cardiomyopathy. Eur Heart J 2001; 22: 2164–70.
Lu C, Dabrowski P, Fragasso G, et al. Effects of trimetazidine on ischemic left ventricular dysfunction in patients with coronary artery disease. Am J Cardiol 1998; 82: 898–901.
Lopaschuk GD. Pharmacologic rationale for trimetazidine in the treatment of ischemic heart disease. Am J Cardivasc Drugs 2003; 3 Suppl. 1: 21–6.
Katz MH. Multivariable analysis: a primer for readers of medical research. Ann Intern Med 2003; 138: 644–5.
Acknowledgments
The authors are indebted to the following investigators who participated in the METRO study: Dr K. Parikh (Ahmedabad), Dr C.N. Manjunath (Bangalore), Dr K. Kunhali (Calicut), Dr A. Pandey (Lucknow), and Dr D. Namjoshi (Mumbai). An administrative grant was provided by Serdia Pharmaceuticals (India) Pvt. Ltd, the manufacturers of original trimetazidine, to cover organizational expenses. The authors are thankful to Serdia Pharmaceuticals (India) Pvt. Ltd for this administrative support. No other financial consideration was involved.
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Iyengar, S.S., Rosano, G.M.C. Effect of Antianginal Drugs in Stable Angina on Predicted Mortality Risk after Surviving a Myocardial Infarction. Am J Cardiovasc Drugs 9, 293–297 (2009). https://doi.org/10.2165/11316840-000000000-00000
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DOI: https://doi.org/10.2165/11316840-000000000-00000