Author + information
- Received October 11, 1995
- Revision received January 22, 1996
- Accepted January 30, 1996
- Published online June 1, 1996.
- Tabassome Madjlessi-Simon, MDa,
- Murielle Mary-Krause, PhD1,∗,
- Frédéric Fillette, MD†,
- Philippe Lechat, MD‡ and
- Patrice Jaillon, MDa
- ↵1Address for correspondenceDr. Tabassome Madjlessi-Simon, Clinical Pharmacology Unit, Saint-Antoine Hospital, 184 Rue du Fbg Saint-Antoine, 75571 Paris Cedex 12, France.
Objectives. We evaluated the prevalence and prognostic significance of transient myocardial ischemia despite beta-adrenergic blockade in patients with coronary artery disease.
Background. Persistence of transient ischemia despite therapy may correspond to a subset of high risk patients with coronary disease. The impact of beta-blocker withdrawal in these patients remains unknown.
Methods. Patients (n = 313) with documented coronary artery disease and beta-blocker therapy, with (group I, n = 84) or without (group II, n = 229) transient ischemia on ambulatory electrocardiographic monitoring, were followed up during 21 ± 9 months for cardiac events (death, myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass surgery and worsening angina). Occurrence of events was compared by log-rank test.
Results. The number of coronary stenoses did not differ significantly between groups I and II. Beta-blocker therapy was discontinued more frequently during follow-up in group II (25% vs. 14% in group I, p = 0.04). Cumulative percentage of death or myocardial infarction, or both, tended to be higher in group I at 30 months (17% vs. 5% in group II, p = 0.09). Coronary angioplasty and bypass surgery were significantly more frequent in group I (p = 0.01 and 0.0008, respectively). Transient ischemia was associated with a higher cumulative probability of adverse events (p = 0.004). The number of coronary stenoses, presence of transient ischemia and beta-blocker withdrawal were the only significant prognostic factors of cardiac events in the Cox model. In group I patients, the relative hazard of cardiac events was increased threefold when beta-blocker therapy was interrupted.
Conclusions. These data suggest that 1) the occurrence of transient ischemia despite beta-blocker therapy identifies a subset of high risk patients with coronary artery disease, and 2) the interruption of beta-blocker therapy increases the risk of adverse cardiac events.
on Behalf of the Amlor-Holter Study Investigators
☆ A complete listing of participating centers and investigators appears in reference 11. This work was presented in part at the 67th Annual Scientific Sessions of the American Heart Association Dallas, Texas, November 1994.
- Received October 11, 1995.
- Revision received January 22, 1996.
- Accepted January 30, 1996.