Author + information
Background: Beta blockers, calcium channel blockers and nitrates are commonly used to manage patients with stable angina. Despite available treatment options, there is yet to be a single preferred agent. The objective of this meta-analysis is to determine the relative efficacy of anti-anginal drugs administered as monotherapy in patients with stable angina.
Methods: A comprehensive literature search was conducted in MEDLINE (1945-Oct 2014) and EMBASE (1974-Oct 2014) to identify treatment comparisons of anti-anginal agents for the management of stable angina. Included articles were English language, randomized controlled trials that compared efficacy of anti-anginal drugs, had an Oxford score ≥ 3, and used monotherapy in a human population with stable angina. Included drugs were drawn from the most recent chronic angina guidelines in the European Heart Journal. Articles were excluded if they did not assess exercise tolerance, did not include ≥ 100 patients, or did not assess patients for ≥ 7 days. Data were screened, evaluated, and entered into Aggregate Data Drug Information System (ADDIS), version 1.16.3, software package to build a Markov Chain Monte Carlo analysis.
Results: The combined searches yielded 1,416 articles. After applying the exclusion criteria, 19 articles were included for analysis. Evaluated endpoints include total time to 1mm ST-segment depression and total time in exercise duration. Among all endpoints, there was no statistically significant difference among agents. Beta blockers and calcium channel blockers were the most efficacious when assessing ranked probabilities. Ivabradine, ranolazine, and amlodipine had the most frequently reported safety events.
Conclusions: The mixed treatment comparison meta-analysis of direct and indirect comparisons found similar efficacy among all anti-anginal therapies. There were no major statistical differences in the reduction of angina symptoms among all different treatment comparisons. In terms of ranked probabilities, beta blockers and calcium channel blockers were most likely to have the greatest effect. Patient preference, cost, and comorbidities should be considered when initiating monotherapy for stable angina.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Updates in Stable Ischemic Heart Disease
Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1125-306
- 2017 American College of Cardiology Foundation