Anti-anginal drugs: Systematic review and clinical implications.

Rita Pavasini, Paolo G Camici, Filippo Crea, Nicolas Danchin, Kim Fox, Athanasios J Manolis, Mario Marzilli, Giuseppe M C Rosano, José L Lopez-Sendon, Fausto Pinto, Cristina Balla, Roberto Ferrari

Journal: International journal of cardiology 2019;283():55-63

PMID: 30538056

Full Text on Elsevier Science View on PubMed

Abstract

BACKGROUND

The cornerstone of the treatment of patients affected by stable angina is based on drugs administration classified as first (beta-blockers, calcium channel blockers, short acting nitrates) or second line treatment (long-acting nitrates, ivabradine, nicorandil, ranolazine and trimetazidine). However, few data on comparison between different classes of drugs justify that one class of drugs is superior to another.

METHODS

We performed a systematic review of the literature following PRISMA guidelines.

INCLUSION CRITERIA

i) paper published in English; ii) diagnosis of stable coronary disease; iii) randomized clinical trial; iv) comparison of two anti-angina drugs; v) a sample size >100 patients; vi) a follow-up lasting at least 2 weeks; vii) paper published after 1999, when a meta-analysis of trials comparing beta-blockers, calcium antagonists, and nitrates for stable angina of Heidenreich et al. was published.

OUTCOME

to establish whether the categorization in first and second line antianginal treatment is scientifically supported.

RESULTS

Eleven trials fulfilled inclusion criteria. The results show that there is a paucity of data comparing the efficacy of antianginal agents. The little data available show that there are not compounds superior to others in terms of improvement in exercise test duration, frequency of anginal attacks, need for sub-lingual nitroglycerin.

CONCLUSION

The categorization of antianginal drug in first and second line is not confirmed.

Address: Centro Cardiologico Universitario, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy. Electronic address: [email protected].; Vita Salute University and San Raffaele Hospital, Via Olgettina Milano, 58-60, 20132 Milan, Italy.; Department of Cardiovascular and Thoracic Sciences, Catholic University, Largo Francesco Vito, 1, 00168 Rome, Italy.; Cardiology, European Hospital Georges-Pompidiou, 20 Rue Leblanc, 75015 Paris, France.; National Heart and Lung Institute, Imperial College and Institute of Cardiovascular Medicine and Science, Royal Brompton Hospital, Sydney Street, London SW36NP, UK.; Department of Cardiology, Asklepeion General Hospital, 1, Vas. Pavlou Street, 16673 Voula, Athens, Greece.; Cardiothoracic Department, Lungarno Antonio Pacinotti, 43, 56126 Pisa, Italy; Nottola Cardiology Division, Località Nottola, 53045, Ospedali Riuniti Valdichiana Sudest, Siena, Italy.; Clinical Academic Group, St George's Hospitals NHS Trust, Blackshaw Road, London SW17 0QT, UK; Department of Medical Sciences, IRCCS San Raffaele, Via della Pisana, 235, 00163 Rome, Italy.; Cardiology Department, Hospital Universitario La Paz, IdiPaz, Paseo de la Castellana 261, Madrid 28036, Spain.; Hospital Universitário de Santa Maria/Centro Hospitalar Lisboa Norte, Centro Académico de Medicina de Lisboa, Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal.; Centro Cardiologico Universitario, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy.; Centro Cardiologico Universitario, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Cona, Ferrara, Italy; Maria Cecilia Hospital, GVM Care & Research, Via Corriera 1, Cotignola, RA, Italy.

DOI: 10.1016/j.ijcard.2018.12.008

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MeSH Terms: Adrenergic beta-Antagonists, Angina, Stable, Calcium Channel Blockers, Humans, Vasodilator Agents