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Antianginal medications and long-term outcomes after elective catheterization in patients with coronary artery
Lan Shen1,2, John P Vavalle2, Samuel Broderick3
1Shanghai Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Insights
Antianginal medications are recommended for stable ischemic heart disease. Their use, particularly beta-blockers, is linked to lower mortality in patients with obstructive coronary artery disease.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Antianginal medications are guideline-recommended for stable ischemic heart disease.
- Real-world data on antianginal drug selection and outcomes are crucial.
Purpose of the Study:
- To evaluate the association between antianginal medication use and patient outcomes.
- To understand drug selection patterns in patients with obstructive coronary artery disease (CAD).
Main Methods:
- A cohort of 5608 patients with obstructive CAD undergoing elective cardiac catheterization was analyzed.
- Medication use was assessed at catheterization or within 3 months post-procedure.
- Cox proportional hazards models were used to evaluate the association between antianginal medication and outcomes.
Main Results:
- Patients prescribed antianginal medications had lower adjusted mortality (HR: 0.75) and mortality or myocardial infarction (HR: 0.83) compared to non-users.
- Beta-blocker use was associated with reduced mortality risk (HR: 0.76).
- Calcium channel blockers and long-acting nitrates were associated with increased mortality risk (HR: 1.16 and HR: 1.20, respectively).
Conclusions:
- Antianginal medications are underutilized in obstructive CAD patients, with non-use linked to higher mortality.
- Beta-blockers demonstrate improved long-term survival in CAD patients, regardless of prior myocardial infarction history.
Background:
Antianginal medications are a class I recommendation by the American College of Cardiology/American Heart Association guidelines for stable ischemic heart disease. We sought to better understand guidance in drug selection and real-life outcomes of antianginal medication use.
Hypothesis:
In patients with stable ischemic heart disease, antianginal medications lower mortality.
Methods:
We evaluated 5608 patients with obstructive coronary artery disease (CAD) on elective cardiac catheterization with follow-up through self-administered questionnaires. Patients were classified as being prescribed a particular medication if they received that medication at index catheterization, or within 3 months postcatheterization. The association between antianginal medication use and outcomes was evaluated using Cox proportional hazards models.
Results:
Compared with the 11% not prescribed any antianginal medication, patients prescribed antianginal medication were more likely to be older and female; have a history of hypertension, diabetes mellitus, peripheral vascular disease, or 3-vessel CAD; have lower adjusted mortality (hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.63-0.89); and experience mortality or myocardial infarction (HR: 0.83, 95% CI: 0.71-0.98). Compared with patients not taking β-blockers (17%), those taking β-blockers had a lower risk of mortality (HR: 0.76, 95% CI: 0.66-0.88). Patients prescribed calcium channel blockers or long-acting nitrates had a higher risk of mortality compared with nonusers (HR: 1.16, 95% CI: 1.04-1.29; HR: 1.20, 95% CI: 1.08-1.34; respectively).
Conclusions:
Antianginal medications are not universally prescribed among obstructive CAD patients; nonuse was associated with higher mortality. For CAD patients with or without prior myocardial infarction, β-blockers were associated with improved long-term survival.
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