title: Antianginal medications and long-term outcomes after elective catheterization in patients with coronary artery disease.
abstract: BACKGROUND
  Antianginal medications are a class I recommendation by the American College of Cardiology/American Heart Association guidelines for stable ischemic heart disease. We sought to better understand guidance in drug selection and real-life outcomes of antianginal medication use.
  
  
  OBJECTIVE
  In patients with stable ischemic heart disease, antianginal medications lower mortality.
  
  
  METHODS
  We evaluated 5608 patients with obstructive coronary artery disease (CAD) on elective cardiac catheterization with follow-up through self-administered questionnaires. Patients were classified as being prescribed a particular medication if they received that medication at index catheterization, or within 3 months postcatheterization. The association between antianginal medication use and outcomes was evaluated using Cox proportional hazards models.
  
  
  RESULTS
  Compared with the 11% not prescribed any antianginal medication, patients prescribed antianginal medication were more likely to be older and female; have a history of hypertension, diabetes mellitus, peripheral vascular disease, or 3-vessel CAD; have lower adjusted mortality (hazard ratio [HR]: 0.75, 95% confidence interval [CI]: 0.63-0.89); and experience mortality or myocardial infarction (HR: 0.83, 95% CI: 0.71-0.98). Compared with patients not taking β-blockers (17%), those taking β-blockers had a lower risk of mortality (HR: 0.76, 95% CI: 0.66-0.88). Patients prescribed calcium channel blockers or long-acting nitrates had a higher risk of mortality compared with nonusers (HR: 1.16, 95% CI: 1.04-1.29; HR: 1.20, 95% CI: 1.08-1.34; respectively).
  
  
  CONCLUSIONS
  Antianginal medications are not universally prescribed among obstructive CAD patients; nonuse was associated with higher mortality. For CAD patients with or without prior myocardial infarction, β-blockers were associated with improved long-term survival.
authors.affiliation: Shanghai Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.|School of Medicine, University of North Carolina, Chapel Hill.
authors.forename: Lan
authors.initials: L
authors.lastname: Shen
authors.affiliation: School of Medicine, University of North Carolina, Chapel Hill.
authors.forename: John P
authors.initials: JP
authors.lastname: Vavalle
authors.affiliation: The Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Samuel
authors.initials: S
authors.lastname: Broderick
authors.affiliation: The Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Linda K
authors.initials: LK
authors.lastname: Shaw
authors.affiliation: The Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Douglas
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000787:Angina Pectoris / Q000453:epidemiology / Q000517:prevention & control*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D006328:Cardiac Catheterization / Q000379:methods*; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D014665:Vasodilator Agents / Q000627:therapeutic use*
chemical_list: D000319:Adrenergic beta-Antagonists; D002121:Calcium Channel Blockers; D014665:Vasodilator Agents
keywords: angina; coronary disease; long-term outcomes; medications