Article

First-line medical management of stable angina generally involves a
beta-blocker (BB) or calcium channel blocker (CCB), with other classes of
medication being added if symptom control is inadequate. Evidence supporting the
appropriate choice of a second-line agent is currently unclear. The objective of
this systematic review was to quantify the clinical benefit of BB, CCBs,
long-acting nitrates (LANs), ranolazine, trimetazidine, ivabradine or nicorandil
added to first-line monotherapy for stable coronary artery disease. METHODS:
Randomised controlled trials comparing the efficacy of antianginal therapies in
patients with stable angina refractory to first-line therapy were identified from
a literature search. Exercise tolerance test (ETT) data and clinical outcomes
were extracted and combined in a series of meta-analyses. RESULTS: A total of 46
qualifying studies were identified, evaluating 71 treatment comparisons. The
combination of ranolazine added to CCB or BB showed positive outcomes across all
outcomes assessed. Other combinations of BB, CCB, LAN and trimetazidine showed
significant benefits for most but not all outcomes. Ivabradine demonstrated
benefits for ETT assessments but these were not matched in clinical domains. No
qualifying studies were identified for nicorandil in an add-on role. CONCLUSION:
Across a range of commonly assessed exercise and clinical outcomes, the
effectiveness of BB+CCB used in combination is broadly confirmed. Ranolazine used
with BB or CCB showed benefits across all outcomes assessed, while LAN and
trimetazidine used with BB or CCB have shown benefits across some outcomes.
Ivabradine added to BB shows inconsistent effects from a single study, whilst
there is no relevant evidence for nicorandil.
CI - (c) The European Society of Cardiology 2014 Reprints and permissions:
sagepub.co.uk/journalsPermissions.nav.

Langue : ANGLAIS