Effect of antianginal drugs in stable angina on predicted mortality risk after surviving a myocardial infarction: A preliminary study (METRO)

Shamanna S. Iyengar, G. M C Rosano

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Background: Although antianginal drugs are used over several months and through to years in stable angina, there is scant evidence regarding their influence on outcomes. The METRO (ManagEment of angina: a reTRospective cOhort) study sought to assess the independent effect of using these drugs on subsequent mortality risk in patients with stable angina. Methods: Consecutive patients with stable angina, receiving at least one antianginal drug (nitrates, β-adrenoceptor antagonists, calcium channel antagonists, trimetazidine, or nicorandil), were selected if they were discharged alive from an intensive care unit following a myocardial infarction (MI). Their case-record data were used in a multivariate logistic regression model to examine the independent association of antianginal drug use prior to the MI with predicted post-discharge, 6-month, all-cause mortality risk. Results: In 353 patients, of whom 287 (81.3%) were men, the mean (± SD) age was 55 (± 10.2) years and duration of treated stable angina was 27.2 (± 24.8) months. The odds ratios (95% CI) of 6-month, all-cause mortality after surviving an MI were: for treatment that included a β-adrenoceptor antagonist, 0.63 (0.26, 1.52; p = 0.309); a calcium channel antagonist, 0.76 (0.12, 2.89; p = 0.638); a nitrate, 0.52 (0.26, 1.05; p = 0.070); nicorandil, 0.62 (0.29, 1.33; p = 0.221); and trimetazidine, 0.36 (0.15, 0.86; p = 0.022). Conclusion: The inclusion of trimetazidine in the antianginal treatment of stable angina is independently associated with a significant reduction in mortality after surviving an MI. This suggests that combining a metabolic agent with drugs that modulate oxygen supply and demand, early in the management of stable angina, may confer a survival benefit.

Original languageEnglish
Pages (from-to)293-297
Number of pages5
JournalAmerican Journal of Cardiovascular Drugs
Issue number5
Publication statusPublished - 2009


ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

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