Effect of antianginal drugs in stable angina on predicted mortality risk after surviving a myocardial infarction: a preliminary study (METRO).
BACKGROUND
Although antianginal drugs are used over several months and through to years in stable angina, there is scant evidence regarding their influence on outcomes. The METRO (ManagEment of angina: a reTRospective cOhort) study sought to assess the independent effect of using these drugs on subsequent mortality risk in patients with stable angina.


METHODS
Consecutive patients with stable angina, receiving at least one antianginal drug (nitrates, beta-adrenoceptor antagonists, calcium channel antagonists, trimetazidine, or nicorandil), were selected if they were discharged alive from an intensive care unit following a myocardial infarction (MI). Their case-record data were used in a multivariate logistic regression model to examine the independent association of antianginal drug use prior to the MI with predicted post-discharge, 6-month, all-cause mortality risk.


RESULTS
In 353 patients, of whom 287 (81.3%) were men, the mean (+/- SD) age was 55 (+/- 10.2) years and duration of treated stable angina was 27.2 (+/- 24.8) months. The odds ratios (95% CI) of 6-month, all-cause mortality after surviving an MI were: for treatment that included a beta-adrenoceptor antagonist, 0.63 (0.26, 1.52; p = 0.309); a calcium channel antagonist, 0.76 (0.12, 2.89; p = 0.638); a nitrate, 0.52 (0.26, 1.05; p = 0.070); nicorandil, 0.62 (0.29, 1.33; p = 0.221); and trimetazidine, 0.36 (0.15, 0.86; p = 0.022).


CONCLUSIONS
The inclusion of trimetazidine in the antianginal treatment of stable angina is independently associated with a significant reduction in mortality after surviving an MI. This suggests that combining a metabolic agent with drugs that modulate oxygen supply and demand, early in the management of stable angina, may confer a survival benefit.
St John's Medical College Hospital, Bangalore, India. dr.iyengar@yahoo.co.in
Shamanna S
SS
Iyengar
Giuseppe M C
GM
Rosano
D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality*; D016017:Odds Ratio; D012189:Retrospective Studies; D012306:Risk; D013534:Survival; D016896:Treatment Outcome
D002317:Cardiovascular Agents