title: Management and outcomes of non-ST elevation acute coronary syndromes in relation to previous use of antianginal therapies (from the Canadian Global Registry of Acute Coronary Events [GRACE] and Canadian Registry of Acute Coronary Events [CANRACE]).
abstract: Randomized trials have established the efficacy of antianginal medications in the treatment of chronic stable coronary disease. Using data from the Global Registry of Acute Coronary Events (GRACE) and Canadian Registry of Acute Coronary Events (CANRACE), we examined the temporal trends in antianginal use (beta blockers, calcium antagonists, and nitrates) before non-ST-elevation acute coronary syndrome presentation from 1999 to 2008 in 10,019 patients. The relationships among previous antianginal use, clinical characteristics on presentation, and in-hospital management and outcomes were examined. Beta blockers were the most commonly used agents, and there was a significant decline in the use of nitrates over time. Compared with patients not on any antianginal therapy before presentation, those on treatment were more likely to be older, female, and have a history of hypertension, diabetes, previous angina, and myocardial infarction; they were less likely to present with positive biomarkers (all p <0.001). Patients not on antianginal therapy before presentation were more likely to undergo coronary angiography and percutaneous coronary intervention and less likely to have recurrent ischemia during hospitalization (all p <0.001). In multivariable analysis, previous antianginal use was independently associated with lower use of coronary angiography in hospital (p = 0.034) but not with in-hospital mortality. In conclusion, there has significant temporal decline in nitrate use before non-ST-elevation acute coronary syndrome. Patients receiving antianginal therapy before presentation more frequently had preexisting cardiovascular disease and previous revascularization and were less likely to present with non-ST-segment elevation MI compared with patients on no antianginal therapies. Previous antianginal use was independently associated with a lower use of coronary angiography in hospital.
authors.affiliation: Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jaskaran S
authors.initials: JS
authors.lastname: Kang
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Yan
authors.forename: Jose
authors.initials: J
authors.lastname: Lopez-Sendon
authors.forename: Yves
authors.initials: Y
authors.lastname: Pesant
authors.forename: John J
authors.initials: JJ
authors.lastname: Graham
authors.forename: David
authors.initials: D
authors.lastname: Fitchett
authors.forename: Graham C
authors.initials: GC
authors.lastname: Wong
authors.forename: Barry F
authors.initials: BF
authors.lastname: Rose
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy*; D015415:Biomarkers / Q000032:analysis; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D006328:Cardiac Catheterization / Q000706:statistics & numerical data; D017023:Coronary Angiography; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009566:Nitrates / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D015415:Biomarkers; D002121:Calcium Channel Blockers; D009566:Nitrates