Table 1.
General ischemic heart disease
| Reference | Inclusion/exclusion | Intervention/Subgroup | n | Mean age, years | Gender (% male) | Time point | PL | SAQ
|
||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AS | AF | TS | DP | EQ-5D | ||||||||
| Bainey et al31 | (I) Diagnosed with IHD. | 1. South Asians | 635 | 62.1 | 77.9 | 1 year | 75.0 (0.91) | 77.0 (1.11) | 86.0 (0.91) | 86.0 (0.75) | 71.0 (0.95) | 0.852 (0.84–0.86) |
| 2. Europeans | 18,934 | 63.5 | 74.0 | 1 year | 80.0 (0.44) | 77.0 (0.52) | 88.0 (0.38) | 89.0 (0.30) | 76.0 (0.40) | 0.877 (0.87–0.88) | ||
| Broddadottir et al30 | (I) Women with IHD who consented to participate in the study. | 1. All ages | 437 | 66.4 | 0.0 | Baseline | 56.4 (1.12) | 75.8 (1.45) | 76.7 (1.23) | 85.9 (0.78) | 59.7 (1.13) | 0.781 (0.77–0.79) |
| 2. Age 32–59 years | 133 | 52.3 | 0.0 | Baseline | 57.4 (2.02) | 72.9 (2.66) | 72.1 (2.18) | 82.0 (1.66) | 52.5 (2.06) | 0.760 (0.75–0.78) | ||
| 3. Age 60–74 years | 190 | 68.2 | 0.0 | Baseline | 60.0 (1.70) | 77.7 (2.26) | 79.0 (1.93) | 87.7 (1.10) | 62.8 (1.71) | 0.797 (0.78–0.81) | ||
| 4. Age 75–88 years | 114 | 79.6 | 0.0 | Baseline | 48.8 (2.06) | 76.6 (2.70) | 78.2 (2.28) | 87.8 (1.24) | 63.2 (2.06) | 0.776 (0.76–0.79) | ||
| Leung et al47 | (I) IHD and eligible for cardiac rehabilitation. | 1. All patients | 1,056 | 66.3 | 71.8 | 9 months | 61.7 (0.64) | 75.1 (0.91) | 86.9 (0.67) | 78.7 (0.78) | 67.3 (0.84) | 0.816 (0.81–0.83) |
| 2. No rehabilitation | 725 | 66.9 | 70.1 | 9 months | 59.0 (0.81) | 71.4 (1.14) | 84.8 (0.87) | 76.5 (0.99) | 65.6 (1.01) | 0.805 (0.79–0.82) | ||
| 3. Rehabilitation <6 months | 148 | 63.3 | 71.9 | 9 months | 68.9 (1.19) | 83.1 (2.09) | 90.9 (1.42) | 85.5 (1.56) | 72.4 (2.09) | 0.847 (0.83–0.86) | ||
| 4. Rehabilitation >6 months | 183 | 65.7 | 72.0 | 9 months | 66.7 (1.29) | 83.3 (1.81) | 91.7 (1.02) | 82.0 (1.73) | 69.7 (2.06) | 0.836 (0.82–0.85) | ||
| Ohldin et al20 | (I) Veterans, IHD: self-reported angina, history of myocardial infarction, coronary artery disease, or a coronary artery revascularization procedure on the screening questionnaire. | 1. Caucasians | 6,704 | 66.3 | 98.3 | Baseline | 50.8 (0.32) | 56.2 (0.33) | 76.5 (0.29) | 83.0 (0.25) | 63.0 (0.31) | 0.781 (0.77–0.79) |
| 2. African Americans | 1,281 | 64.0 | 98.6 | Baseline | 51.9 (0.72) | 57.6 (0.85) | 76.0 (0.69) | 77.6 (0.70) | 58.5 (0.77) | 0.769 (0.76–0.78) | ||
| Fathi et al24 | (I) Angina, symptomatic IHD, unsuitable for revascularization. (E) LVEF <30%, could not comply with follow-up, had a condition that precluded the performance of stress testing, and had compromised life expectancy. | 1. Usual therapy of lipids (target LDL <116) | 30 | 63.4 | 80.0 | Baseline | 59.0 (4.74) | 57.0 (6.20) | 64.0 (5.47) | 85.0 (2.73) | 59.0 (4.38) | 0.775 (0.74–0.81) |
| 12 weeks | 58.0 (4.92) | 64.0 (4.74) | 65.0 (5.84) | 82.0 (3.28) | 57.0 (4.56) | 0.767 (0.74–0.80) | ||||||
| 2. A ggressive lipid reduction/target LDL <77 | 30 | 63.9 | 77.0 | Baseline | 67.0 (4.56) | 64.0 (4.92) | 72.0 (5.84) | 92.0 (2.55) | 60.0 (4.92) | 0.802 (0.77–0.83) | ||
| 12 weeks | 73.0 (4.19) | 78.0 (5.29) | 80.0 (4.56) | 91.0 (1.82) | 70.0 (4.01) | 0.842 (0.81–0.87) | ||||||
| Moore et al25 | (I) Refractory angina (rejected for revascularization) and referred to refractory angina clinic. | Refractory angina program | 69 | 62.3 | 81.0 | Baseline | 25.2 (1.49) | 32.8 (2.85) | 26.9 (2.32) | 62.8 (2.80) | 31.3 (2.38) | 0.605 (0.58–0.63) |
| 1 year | 27.7 (1.73) | 43.5 (3.32) | 37.7 (2.78) | 72.0 (2.78) | 42.9 (3.17) | 0.649 (0.63–0.67) | ||||||
| Spertus et al12 | (I) Chronic, stable, symptomatic IHD, documented history of coronary disease (prior MI, coronary revascularization, or history of typical angina pectoris), taking at least 2 regular antiangina medications for control of symptoms. (E) Hospitalizations within 4 months, aortic stenosis, EF <40%, sick sinus syndrome, advanced heart block, or other significant comorbidity limiting life expectancy. |
1. Usual antianginal medications | 49 | 64.6 | NA | Baseline | 54.2 (3.61) | 57.1 (3.41) | 66.9 (3.52) | 83.6 (2.07) | 55.3 (3.14) | 0.760 (0.74–0.78) |
| 2. Long-acting diltiazem ± nitroglycerin patches ± atenolol | 51 | 65.3 | NA | Baseline | 48.9 (3.05) | 50.5 (3.01) | 56.7 (3.87) | 80.6 (2.31) | 48.7 (2.99) | 0.724 (0.70–0.75) | ||
| Beltrame et al13 | (I) Stable angina. Not required to have ongoing angina symptoms. | 2,031 | 71.0 | 64.0 | Baseline | 70.0 (0.62) | 63.0 (0.59) | 84.0 (0.51) | 90.0 (0.31) | 70.0 (0.54) | 0.843 (0.84–0.85) | |
| Makolkin and Osadchiy14 | (I) Stable angina with average of >3 angina attacks/week, 1–2 antianginal agents with hemodynamic action at stable doses at the time of inclusion for ≥3 months. (E) NYHA class ≥II, unstable angina, recent MI or stroke within 6 months, severe arrhythmia or conduction impairment. |
Trimetazidine and conventional therapy | 846 | 58.7 | 61.0 | Baseline | 50.7 (0.70) | 57.6 (0.90) | 33.3 (0.70) | 62.3 (0.70) | 36.7 (0.60) | 0.667 (0.65–0.68) |
| 8 weeks | 61.0 (0.60) | 92.5 (0.70) | 55.6 (0.80) | 77.4 (0.50) | 55.5 (0.70) | 0.751 (0.74–0.76) | ||||||
| Stone et al15 | (I) Age ≥18 years, chronic stable angina and ≥3 episodes of angina/week despite treatment with 10 mg of amlodipine. (E) NYHA class IV CHF, prior MI, unstable angina within 2 months, active acute myocarditis, pericarditis, hypertrophic cardiomyopathy, uncontrolled hypertension, history of torsades de pointes, agents to prolong QTc interval, QTc interval ≥500 msec, receiving inhibitors of cytochrome P450-3A4, hepatic disease, creatinine clearance <30 mL/min, chronic illness likely to interfere with protocol compliance, taking any digitalis preparation, perhexiline, trimetazidine, beta-blockers, or calcium channel blockers other than amlodipine, proscribed antianginal medications within 4 weeks before initiation of the study drug, participation in another investigative trial within 30 days before study start. |
1. Placebo + amlodipine | 283 | 61.3 | 73.0 | Baseline | 48.9 (1.02) | 57.2 (1.05) | 40.0 (0.88) | 75.4 (0.83) | 41.5 (1.05) | 0.687 (0.67–0.70) |
| 2. Ranolazine + amlodipine | 281 | 62.0 | 72.0 | Baseline | 49.2 (1.03) | 54.7 (1.07) | 40.6 (0.78) | 74.6 (0.85) | 41.6 (1.02) | 0.688 (0.68–0.70) | ||
| Maxwell et al16 | (I) CCS II and III stable angina and ≥1 mm ST depression during treadmill exercise testing before achieving 14.5 Mets. (E) Unstable angina, MI, major surgery or angioplasty within the past 3 months, symptomatic HF, impaired renal or hepatic function, or any other systemic illness, congenital heart disease, valvular heart disease, atrial fibrillation, uncontrolled hypertension, type 1 diabetes, diseases other than IHD that would interfere with treadmill testing. |
Dietary management (2 L-arginine-enriched nutrient bars/day) | 36 | 65.9 | 77.8 | Baseline | 60.0 (2.33) | 54.0 (2.66) | 64.0 (3.50) | 70.0 (3.16) | 53.0 (3.33) | 0.758 (0.74–0.78) |
| 1. 2 weeks of dietary management | 64.0 (2.50) | 67.0 (3.66) | 67.0 (3.16) | 77.0 (2.50) | 61.0 (2.66) | 0.787 (0.77–0.81) | ||||||
| 2. 2 weeks of placebo | 60.0 (3.50) | 60.0 (3.66) | 66.0 (4.00) | 70.0 (3.83) | 56.0 (3.83) | 0.766 (0.74–0.79) | ||||||
| Deaton et al17 | (I) Stable, symptomatic IHD and coronary anatomy suitable for PCI. | 1. Diabetic | 320 | 62.0 | 84.0 | Baseline | 60.0 (1.48) | 49.0 (1.84) | 64.0 (1.56) | 83.0 (1.17) | 47.0 (1.45) | 0.750 (0.74–0.76) |
| 2. Nondiabetic | 693 | 61.0 | 85.0 | Baseline | 65.0 (1.02) | 51.0 (1.29) | 66.0 (1.02) | 85.0 (0.75) | 49.0 (0.98) | 0.767 (0.76–0.78) | ||
| de Jong-Watt et al54 | (I) Elective, first time coronary angiogram, planned angiography date 3–8 weeks from the time of referral, understand written or spoken English. (E) Previous coronary angiography, CABG surgery, PCI, or other cardiac procedures such as valve surgery, awaiting coronary angiography in hospital. |
Coronary angiogram | 42 | 64.6 | 67.5 | Baseline | 60.0 (4.29) | 46.3 (3.95) | 57.5 (4.67) | 83.1 (2.55) | 47.7 (3.63) | 0.746 (0.72–0.77) |
| 1 week pre-angiography | 57.7 (4.29) | 48.8 (3.99) | 54.3 (4.58) | 79.4 (2.75) | 42.3 (3.36) | 0.724 (0.70–0.75) | ||||||
Note: SAQ values include standard error; EQ-5D values include 95% confidence intervals.
Abbreviations: I, inclusion criteria; E, exclusion criteria; EF, ejection fraction; IHD, ischemic heart disease; LVEF, left ventricular ejection fraction; LDL, low-density lipoprotein; MI, myocardial infarction; NYHA class, New York Heart Association classification; CHF, congestive heart failure; Mets, metabolic equivalents; HF, heart failure; PCI, percutaneous coronary intervention; CABG, coronary artery bypass graft; CCS, Canadian Cardiovascular Society; NA, not available; SAQ, Seattle Angina Questionnaire; PL, physical limitation; TS, treatment satisfaction; AF, angina frequency; AS, angina stability; DP, disease perception; EQ-5D, European Quality of Life-5 Dimensions; QTc, corrected QT.