Do medications which reduce angina influence long-term mortality after a heart attack?

The French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI), is a nationwide survey of patients hospitalised for acute myocardial infarction in France over a one-month period, at the end of 2005. Patients included will be followed for a period of 10 years after the initial heart attack. At three years, fewer than 5% of the patients have been lost to follow-up.

Of a population of 3,670 patients included in the registry, 3,262 survived the initial hospitalisation and had a complete prescription at discharge. Among them, 1266 (39%) received antianginal agents other than beta-blockers. Calcium-channel blockers were prescribed to 16% (dihydropyridines 10.5%, diltiazem 2% or verapamil 3%), nitrates to 19%, molsidomine to 3%, nicorandil to 9% and trimetazidine to 4.5% of patients. In addition, beta-blockers were prescribed to 77% of the patients. Patients who received antianginal agents were older and had more severe infarctions than those who did not receive such medications.

Three-year survival was 77% in patients treated with antianginal agents, compared with 86% in those who were not. After taking into account the initial profile of the patients and the severity of their heart attacks, prescription of antianginal medications was associated with a small (7%), non significant increase in the risk of dying in the 3 years following the heart attack.

When the different antianginal agents were analysed individually, none was associated with either a decreased or an increased risk of dying, except for molsidomine. Prescription of nitrates, the most ancient antianginal medication available, was associated with a trend to increased risk of death (+ 22%) which was not statistically significant; molsidomine was prescribed in a small number of patients (n=111) and was associated with a significant excess of deaths (+ 57%).

There was no evidence of any benefit or harm with respect to long-term mortality with most antianginal agents prescribed in patients having sustained a heart attack. The findings of possible increased hazard associated with use of nitrates, and more importantly of molsidomine, are intriguing and deserve further studies.

Provided by European Society of Cardiology