Abstract 19041: The Effectiveness of Intensive Medical Treatment of Patients Initially Referred as Refractory Angina: Preliminary Results

Abstract

Introduction: Refractory angina is a major clinical challenge. Many patients (pt) may be erroneously diagnosed as refractory angina (RA), if not on intensive medical therapy. Objectives: To evaluate the impact of intensive medical treatment on angina functional class, angina episodes and nitrate consumption per week in pt initially diagnosed as RA.

Methods: 63 pt (68% male, 62±11 years) were included based on the following criteria: 1) disabling symptoms; 2) objectively documented myocardial ischemia; 3) coronary anatomy unsuitable for conventional myocardial revascularization procedures. Medical visits ocurred every 4 weeks during a 3-month period (V0 to V3). Pt were evaluated in each visit according to the functional class(CCS), and angina episodes and sublingual nitrate consumption per week were registered in pt's angina diary. Optimized medical therapy was strongly encouraged based on pt’s tolerance. Statistical analysis included the paired-sample T-test and logistic regression.

Results: There was an overall improvement in CCS class between V0 to V3 of 0.89±1 (p<0.001), from 2.9±0.8 to 2.1±1.0; a decrease in angina episodes of 3.2±6.2 (p=0.007), from 6.9±7.6 to 3.7±4.5, and in sublingual nitrates per week of 2.2±4.7 (p=0.04), from 4.7±5.0 to 2.4±2.6. In V0 and V3, anti-ischemic drugs were used as follows (%), respectively: beta-blockers (89 vs. 95), calcium channel blockers (78 vs. 89), long-acting nitrates (92 vs. 100), and trimetazidine (36 vs. 95), aspirin (81 vs. 81), statins (97 vs.98). There were non-significant changes in: mean HR (bpm) from 65±11 to 63±10 (p=0.09), in mean SBP from 125±22 to 122±22 (p=0.24), and DBP from 72±12 to 70±13mmHg (P=0.18), in mean waist circumference (cm) from 104±11 to 104±10(p=0.67) and in mean weight (kg) from 79±17 to 80±16 (p=0.39). The only predictive factor of clinical improvement found was CCS (p=0.04).

Conclusion: Pt enrolled in this clinical program, although initially diagnosed as refractory angina, experienced a significant improvement in their clinical presentation, although little medical management changes were made. We believe that the regular visits at shorter intervals may have led to a better treatment adherence, emotional easiness and self-confidence.