Transient myocardial ischemia after abrupt withdrawal of antianginal therapy in chronic stable angina

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Abstract

In 47 patients with chronic stable angina and proven coronary artery disease, abrupt withdrawal of beta-adrenoceptor blocking agents either as monotherapy or in combination with calcium antagonists (group 1, n = 25) was compared with abrupt withdrawal of calcium antagonist monotherapy (group 2, n = 22) as regards the occurrence of cardiac events and total ischemic activity detected by ambulatory monitoring. Reinstitution of medical therapy was required in 6 patients (4 in group 1 and 2 in group 2). Ambulatory monitoring was initiated for 36 hours on 3 occasions: before withdrawal, and again 2 and 5 days after withdrawal. The first 2 monitorings were performed in the hospital and the last during daily activity. In group 1, the frequency of total ischemia increased by 64 and 148% from monitoring occasions 1 to 2 and 1 to 3, respectively (p less than 0.01), and silent ischemia increased by 100 and 129%, respectively (p less than 0.01). However, no significant change in transient myocardial ischemia was noted in group 2. Heart rate at onset of ischemia increased significantly in group 1 (p less than 0.01), in contrast to group 2 which had significant increases only in out-of-hospital values (p less than 0.05). These results indicate that a rebound increase in ischemic activity (mainly silent) occurs after abrupt withdrawal of beta-receptor blockade in patients with chronic stable angina. This increase in ischemic activity may be caused by increased myocardial oxygen demand.

Original languageEnglish
JournalAmerican Journal of Cardiology
Volume61
Issue number15
Pages (from-to)1219-22
Number of pages4
ISSN0002-9149
Publication statusPublished - 1. Jun 1988

Keywords

  • Adrenergic beta-Antagonists
  • Angina Pectoris
  • Calcium Channel Blockers
  • Chronic Disease
  • Coronary Angiography
  • Coronary Disease
  • Drug Therapy, Combination
  • Electrocardiography
  • Heart Rate
  • Humans
  • Monitoring, Physiologic
  • Substance Withdrawal Syndrome
  • Time Factors
  • Comparative Study
  • Journal Article

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