A critical evidence-based summary of the use of beta-blockers in stable coronary artery disease

BackgroundDrug-eluting stent-induced vasospastic angina (DES-VSA) has emerged as a novel complication in the modern era of percutaneous coronary intervention (PCI). Although beta blockers (BBs) are generally recommended for coronary heart disease, they may promote incidence of DES-VSA. This study aimed to compare the effects of calcium channel blockers (CCBs) perceived to be protective against DES-VSA and BBs on subsequent coronary events after second-generation drug-eluting stent implantation.MethodsIn this multicentre prospective, randomised study, 52 patients with coronary artery disease who underwent PCI for a single-vessel lesion with everolimus-eluting stent placement were randomised into post-stenting BB (N=26) and CCB (N=26) groups and followed for 24 months to detect any major cardiovascular events (MACE). A positive result on acetylcholine provocation testing during diagnostic coronary angiography (CAG) at 9 months was the primary endpoint for equivalence. MACE included all-cause death, non-fatal myocardial infarction, unstable angina, cerebrovascular disease or coronary revascularisation for stable coronary artery disease after index PCI.ResultsAt 9 months, 42 patients (80.8%) underwent diagnostic coronary angiography and acetylcholine provocation testing. Among them, seven patients in each group were diagnosed with definite vasospasm (intention-to-treat analysis 26.9% vs 26.9%, risk difference 0 (−0.241, 0.241)). Meanwhile, the secondary endpoint, 24-month MACE, was higher in the CCB group (19.2%) than in the BB group (3.8%) (p=0.01). In detail, coronary revascularisation for stable coronary artery disease was the predominant endpoint that contributed to the greater proportion of MACE in the CCB group (CCB (19.2%) vs BB (3.8%), p=0.03).ConclusionsThe incidence of acetylcholine-induced coronary artery spasms did not differ between patients receiving BBs or CCBs at 9 months after PCI. However, a higher incidence of 2-year MACE was observed in the CCB group, suggesting the importance of BB administration.Trial registration numberThis study was registered at the Japanese University Hospital Medical Information Network (UMIN) Clinical Trial Registry (The Prospective Randomized Trial for Optimizing Medical Therapy After Stenting: Calcium-Beta Trial; UMIN000008321, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000009536).

Download Full-text

Evaluation of prescribing pattern of drugs use in patients of coronary artery disease at a tertiary care hospital

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20183491 ◽

2018 ◽

Vol 7 (9) ◽

pp. 1792

Author(s):

Mahesh N. Belhekar ◽

Tejal C. Patel ◽

Mohit Kumar Singh ◽

Prasad R. Pandit ◽

Kiran A. Bhave ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Ace Inhibitors ◽

Tertiary Care Hospital ◽

Beta Blockers ◽

Tertiary Care ◽

Evidence Based ◽

Care Hospital ◽

Artery Disease

Background: Coronary artery disease (CAD) is a major cause responsible for mortality more in younger age group than in elderly. Studies have reported underuse of four evidence based medicines namely aspirin, β-blockers, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), and statins in patients with CAD, particularly in developing countries. Therefore, this study was planned to analyse the prescriptions of patients with CAD to determine the appropriateness of the prescriptions.Methods: After obtaining the Institutional ethics committee permission, a cross sectional observational study was conducted at a tertiary care hospital. Total 150 patients were enrolled from the outpatient department, wards and intensive care unit of medicine department. Total 150 patients’ prescriptions presenting with varied category of CAD were screened and analysed.Results: The most common categories of CAD encountered was ST segment elevated myocardial infarction (N=50, 33%) followed by chronic stable angina (N=29, 20%). Among the drugs prescribed, antiplatelet drugs were prescribed to 135 (90%), hypolipidemics to 134 (89%), nitrates to 114 (76%), beta blockers to 97 (65%), ACE inhibitors to 94 (64%), anticoagulants to 60 (40%) and miscellaneous drugs to 52 (35%), patients. Of 68 (45%) patients with type 2 diabetes mellitus, 15 (22%) were prescribed only metoprolol and others were given ACE-I or ARBs.Conclusions: Among four evidence based drugs, use of 3 drugs, antiplatelets, beta blockers and hypolipidemics was apparent in 90% of prescriptions. Use of ACE inhibitors and ARBs was observed in type 2 diabetic patients with CAD, reflecting rational prescribing behavior of clinicians.

Download Full-text

Impact of Chronic Kidney Disease on Use of Evidence-Based Therapy in Stable Coronary Artery Disease: A Prospective Analysis of 22,272 Patients

PLoS ONE ◽

10.1371/journal.pone.0102335 ◽

2014 ◽

Vol 9 (7) ◽

pp. e102335 ◽

Cited By ~ 11

Author(s):

Paul R. Kalra ◽

Xavier García-Moll ◽

José Zamorano ◽

Philip A. Kalra ◽

Kim M. Fox ◽

...

Keyword(s):

Coronary Artery Disease ◽

Chronic Kidney Disease ◽

Coronary Artery ◽

Kidney Disease ◽

Stable Coronary Artery Disease ◽

Evidence Based ◽

Prospective Analysis ◽

Artery Disease ◽

Evidence Based Therapy

Download Full-text

Factors associated with the discontinuation of evidence-based cardiovascular therapies in patients with stable coronary artery disease: a primary care perspective

European Journal of Cardiovascular Prevention & Rehabilitation ◽

10.1097/hjr.0b013e32831a47f3 ◽

2009 ◽

Vol 16 (1) ◽

pp. 34-38 ◽

Cited By ~ 2

Author(s):

Jose M. Mostaza ◽

Carlos Lahoz ◽

Raquel Martín-Jadraque ◽

Miguel A. SanMartín ◽

Ignacio Vicente ◽

...

Keyword(s):

Primary Care ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Stable Coronary Artery Disease ◽

Evidence Based ◽

Factors Associated ◽

Artery Disease

Download Full-text

Features of diagnosis and treatment of patients with stable coronary artery disease at initially normal arterial pressure

Medical Council ◽

10.21518/2079-701x-2018-16-40-44 ◽

2018 ◽

pp. 40-44

Author(s):

I. I. Shaposhnik ◽

N. V. Vvedenskaya

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Arterial Pressure ◽

Beta Blockers ◽

Stable Coronary Artery Disease ◽

Full Range ◽

Disease Onset ◽

Channel Blockers ◽

First Choice ◽

Artery Disease

Of 875 patients being under the clinical follow-up at one of the polyclinics in Chelyabinsk, 216 (24.7%) had coronary artery disease (CAD) without arterial hypertension (AH) in past medical history. The authors conducted the comparative study of risk factors and clinical and instrumental features of the disease in 50 patients with isolated coronary artery disease and in 50 patients with coronary artery disease against the background of AH. It was found that the disease onset was more often manifested in the form of angina pectoris in patients with stable coronary artery disease without AG , and in the form of myocardial infarction in patients with CAD and AH. Pathological heredity, obesity, diabetes mellitus were more common in patients with the combination of CAD and AH. Stenosis of over 50% of at least one coronary artery is more often identified in patients with CAD and normal arterial pressure (AP). The full range of beta-blockers and calcium channel blockers may be prescribed to patients with CAD without AH in no more than 20% of cases due to excess drop in AP. The prescription of anti-ischemic drugs trimetazidine OD and ivabradine increased the CAD without AH, where these drugs probably should be referred to the first choice drugs.

Download Full-text