Health

Diltiazem not effective in patients with angina, CAD


“Tijn PJ Jansen, MD, PhD candidate in the department of cardiology at Radboud University Medical Center, Nijmegen, Netherlands, said during a presentation at the American College of Cardiology Scientific Sessions.

Guidelines recommend the use of calcium channel blockers in coronary artery dysfunction, and diltiazem is one of the most frequently prescribed drugs in these patients. However, these recommendations are based on unlicensed trials. The effects of diltiazem have not been studied in ANOCA patients in a placebo-controlled, randomized, blinded trial.. “

All patients with chronic angina occurring at least twice weekly and coronary vasomotor dysfunction confirmed by the presence of vasospasm and/or microvascular dysfunction, defined is the coronary flow reserve.

The primary goal was successful treatment at 6 weeks, defined as normalization of one of the abnormal parameters of coronary vasomotor dysfunction and none of the normal parameters becoming abnormal.

Of the 73 patients who received a second coronary function test, there was no intergroup difference in coronary function test score improvement, Jansen said, noting that there was also no difference within the cohort. with coronary artery spasm or in the group with coronary microvascular dysfunction.

However, he said, more patients in the diltiazem group than in the placebo group progressed from pericardial spasm to microvasospasm or no spasm.

The summary scores of the Seattle angina questionnaire did not differ between groups, nor did the RAND-36 quality of life score, nor any data, were available, the researchers said. on microvascular dysfunction, according to the researchers.

Treatment with diltiazem for six weeks was not effective in improving coronary artery dysfunction, symptoms, or quality of life compared with placebo.‘ said Jansen.

“Diltiazem seems to reduce epicardial constriction. However, large trials are needed on the effects of medical therapy on individual organs. We believe the study is the first to use functional testing. This repeat coronary artery provides the foundation for future studies.. “

The data has been published in JACC: Cardiovascular imaging.

Editorial Board Member C. Noel Bairey Merz, MD, FACC, FAHA, professor of cardiology and director of the Barbra Streisand Women’s Heart Center at the Smidt Heart Institute in Cedars-Sinai, said the study “is a prime example of pragmatic testing, but we know as treating doctors that not everything works for everyone.

This study is an example of how to every complex problem, having a simple answer is wrong. I think maybe the reason this trial is so negative is that it’s so heterogeneous. “

By contrast, she says, the CorMicA trial shows that calcium channel blockers can be effective in this population, but only if doctors can adjust the medication and give it in combination with other therapies if needed.

Source: Medindia



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