Document Detail

Transient myocardial ischemia during daily life in rest and exertional angina pectoris and comparison of effectiveness of metoprolol versus nifedipine.
MedLine Citation:
PMID:  2018012     Owner:  NLM     Status:  MEDLINE    
The clinical characteristics of 65 patients with mixed angina were classified by means of (1) a questionnaire investigating the proportion of symptoms occurring at rest and on effort, (2) an exercise stress test, (3) 24-hour ambulatory Holter monitoring, and (4) coronary arteriography. According to the questionnaire, the proportion of effort-induced anginal episodes ranged from 1 to 99%. The ischemic threshold during exercise testing ranged from 110 x 10(2) to 350 x 10(2) mm Hg x beats/min. At least 1 episode of ST-segment depression was observed in 29 of the 65 patients during Holter monitoring. Ischemic episodes during Holter monitoring were more frequent (p less than 0.05) in patients reporting greater than or equal to 50% of anginal attacks on effort, with moderate to severe limitation of exercise capacity and with multivessel coronary artery disease. The effect on ambulatory ischemia of a 6-week treatment with a beta blocker (metoprolol CR, 200 mg once daily) or a dihydropyridine calcium antagonist (nifedipine retard 20 mg twice daily) were then compared according to a double-blind, parallel group design. Metoprolol significantly reduced the number and duration of the ischemic episodes during daily life (p less than 0.05) irrespective of the patients' clinical characteristics. Nifedipine was ineffective, particularly in patients with angina predominantly on effort and with a moderate to severe reduction in exercise tolerance. It is concluded that in patients with mixed angina, ischemic episodes during daily life are more likely to occur in patients with a clinical presentation suggesting poor coronary reserve.(ABSTRACT TRUNCATED AT 250 WORDS)
D Ardissino; S Savonitto; K Egstrup; P Marraccini; G Slavich; M Rosenfeld; G A Feruglio; P Roncarolo; M P Giordano; I Wahlqvist
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  The American journal of cardiology     Volume:  67     ISSN:  0002-9149     ISO Abbreviation:  Am. J. Cardiol.     Publication Date:  1991 May 
Date Detail:
Created Date:  1991-05-22     Completed Date:  1991-05-22     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  0207277     Medline TA:  Am J Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  946-52     Citation Subset:  AIM; IM    
Division of Cardiology, IRCCS Policlinico San Matteo, Pavia, Italy.
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MeSH Terms
Angina Pectoris / classification,  drug therapy,  physiopathology
Circadian Rhythm / physiology
Coronary Angiography
Coronary Disease / drug therapy*,  physiopathology
Double-Blind Method
Electrocardiography, Ambulatory
Metoprolol / adverse effects,  therapeutic use*
Middle Aged
Nifedipine / adverse effects,  therapeutic use*
Physical Exertion / physiology*
Reg. No./Substance:
21829-25-4/Nifedipine; 37350-58-6/Metoprolol

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