Medical treatment of patients with stable angina pectoris referred for coronary angiography: Failure of treatment or failure to treat

Abstract

SummaryBackground: Patients referred for elective coronary arteriography because of stable angina pectoris frequently do not receive appropriate medical therapy prior to arteriography. Persistence of symptoms due to lack of appropriate therapy may influence the decision to catheterize and the treatment chosen following catheterization.Hypothesis: The present study evaluates whether patients with stable angina pectoris referred for cardiac catheterization received optimal therapy prior to the procedure. We also evaluated whether medical therapy was optimized as a result of the hospitalization for catheterization.Methods: We evaluated prospectively the adequacy of medical therapy in 333 consecutive patients undergoing elective coronary arteriography. Of these, 160 had stable angina pectoris as their main problem and constituted the study group.Results: Mean duration of angina was 7.5 ± 6.3 months. Canadian Cardiovascular Society angina grade 1 was present in 20, grade 2 in 77, grade 3 or 4 in 63 patients. Arteriography showed a ≥ 50% coronary stenosis in 141 of 160 patients. Aspirin was used by 96%, and 86% received at least one drug aimed at relieving anginal symptoms: beta blockers in 69%, calcium blockers in 30%, and long-acting nitrates in 29%. Antianginal drugs and drugs aimed at treating risk factors were usually taken at a low, subtherapeutic dosage. Only 35 of 110 patients taking beta blockers had a resting heart rate of ≤ 60/min. Following catheterization, 88 of 141 patients with coronary stenosis of ≥ 50% underwent percutanous intervention and 5 had urgent surgery. Optimization of treatment was advised in only 7 of 48 patients for whom medical therapy or elective surgery was recommended.Conclusion: Patients with stable angina pectoris are frequently referred for cardiac catheterization without making a serious attempt to control their symptoms by medical therapy.

The impact of diabetes on one-year health status outcomes following acute coronary syndromes

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Nitrates as an Integral Part of Optimal Medical Therapy and Cardiac Rehabilitation for Stable Angina: Review of Current Concepts and Therapeutics

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Association Between Angina and Treatment Satisfaction after Myocardial Infarction

“…This finding is consistent with prior studies suggesting chronic angina is undertreated in clinical practice. 17,18 However, it is surprising that the prevalence of angina is so high so soon after hospitalization for a cardiac event in an era of early invasive treatment. Angina has been shown to be predictive of subsequent mortality and cardiac events and is associated with diminished functional status and quality of life.…”