Trimetazidine and Bisoprolol to Treat Angina in Symptomatic Patients: Post Hoc Analysis From the CHOICE-2 Study
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ORIGINAL RESEARCH
Trimetazidine and Bisoprolol to Treat Angina in Symptomatic Patients: Post Hoc Analysis From the CHOICE-2 Study Maria Glezer . on behalf of the CHOICE-2 study investigators
Received: September 23, 2020 Ó The Author(s) 2020
ABSTRACT Introduction: Angina is the cardinal symptom of chronic coronary syndrome (CCS), which is the leading cause of death worldwide. As such, the control of angina is important. The current guidelines recommend beta blockers (BB) or calcium channel blockers to reduce angina, yet many patients with stable angina remain symptomatic. It has been suggested that combining trimetazidine (TMZ), an anti-ischemic agent, with a BB is beneficial for symptomatic patients. Bisoprolol, a BB, is often used to treat patients with CCS, yet no data are currently available regarding the efficacy of bisoprolol combined with TMZ in patients who remain symptomatic despite receiving bisoprolol. Methods: The aim of this post-hoc analysis of the CHOICE-2 study was to evaluate the efficacy and safety of TMZ 35 mg twice daily in combination with different bisoprolol doses in symptomatic patients with stable angina patients receiving hemodynamic therapy in a real-world clinical setting. Results: This analysis involved 221 patients (mean [± standard deviation] age 64.8 ± 8.9 years) with stable angina. The mean number of M. Glezer (&) Department of Cardiology, Functional and Ultrasound Diagnostics, Sechenov First Moscow State Medical University, Moscow, Russia e-mail: [email protected]
weekly angina episodes gradually fell from 6.2 ± 5.3 at inclusion (M0) to 1.5 ± 1.9 at 6 months after treatment initiation (M6) with combined TMZ–bisoprolol therapy (P \ 0.001). The number of patients assessed to be anginafree increased almost sixfold from 5.4% (12/ 221) at M0 to 33.9% (74/221) at M6. Exercise capacity improved, as measured by walking distance, from 308 ± 207 m at M0 to 497 ± 253 m at M6 (P \ 0.05). The number of patients with Canadian Cardiovascular Society class 1 angina increased by tenfold during the study, whereas those with class 3 angina decreased by threefold. Conclusion: The TMZ–bisoprolol combination is a rapidly effective treatment for reducing the frequency of angina attacks and the use of short-acting nitrates in patients with stable angina in a real-world clinical setting. The benefits of this combination therapy was observed as early as 2 weeks after treatment initiation and the treatment was well tolerated. Trial Registration: ISRCTN identifier: ISRCTN65209863 Keywords: Angina; Bisoprolol; clinical setting; Trimetazidine
Real-world
Cardiol Ther
Key Summary Points Why carry out this study? Angina remains a therapeutic problem in current real-life medical practice despite current conventional first-line hemodynamic anti angina therapies. Bisoprolol is one of the most widely used beta blockers (BB) for the relief of angina in patients with chronic coronary syndrome. Trimetazidine (TMZ), an anti-ischemic agent, has demonstrated additional angina relief in patients who remain symptomatic wh
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