Author + information
- Received November 30, 1995
- Revision received March 6, 1996
- Accepted March 11, 1996
- Published online July 1, 1996.
- Thomas von Arnim, MD∗,
- TIBBS Investigators
- ↵∗Address for correspondence: Dr. Thomas von Armin, I. Medizinische Abteilung, Krankenanstalt Roles Kruez, Nymphenburger Strasse 163, 80634 Munich, Germany.
Objectives. The Total Ischemic Burden Bisoprolol Study (TIBBS) follow-up examined cardiac event rates in relation to translent ischemia and its treatment.
Background. It is nuclear whether transient ischemia on the ambulatory electrocardiogram has prognostic implications in stable angina and whether medical treatment can improve the prognosis.
Methods. The TIBBS trial was an 8-week, randomized, controlled comparison of the effects of bisoprolol and nifedipine on transient ischemic episodes in patients with stable angina pectoris. Of the 545 patients screened, 520 (95.4%) could be followed up. Rates of cardiac and noncardiac death, nonfatal acute myocardial infarction, hospital admission for unstable angina and need for coronary artery bypass graft surgery or percutaneous transluminal coronary angioplasty were recorded.
Results. A total of 145 events occurred in 120 (23.1%) of 520 patients. Patients with more than six episodes had an event rate of 32.5% compared with 25.0% for patients with two to six episodes and 13.2% for patients with less than two episodes (p < 0.001). Hard events (death, acute myocardial infarction, hospital admission for unstable angina pectoris) were more frequent in patients with two or more ischemic episodes (12.1% vs. 4.7%, p = 0.0049). Patients with a 100% response rate of transient ischemic episodes during the TIBBS trial had a 17.5% event rate at 1 year compared with 32.3% for non-100% responders (p = 0.008). Patients receiving bisoprolol during the TIBBS trial had a lower event rate (22.1%) at 1 year than patients randomized to nifedipine (33.1%, p = 0.033).
Conclusions. In patients with stable angina pectoris, frequent episodes of transient ischemia are a marker for an increased event rate. A 100% response to medical treatment reduces the event rate. The greater reduction of ischemia with bisoprolol than nifedipine during the TIBBS trial translated into animproved outcome at 1 year.
☆ This study was supported by Merck KGaA, Darmstadt, Germany, A complete list of the TIBBS Investigators appears in reference 26.
- Received November 30, 1995.
- Revision received March 6, 1996.
- Accepted March 11, 1996.