Abstract 16279: Does the Number of Antianginals Influence Clinical Outcomes and Quality of Life in Stable Ischemic Heart Disease? Insights From the BARI2D Trial

Abstract

Introduction: Medical therapy is essential for managing stable ischemic heart disease (SIHD), including anti-anginals. remains unclear whether combining anti-anginal agents provides benefits beyond monotherapy in terms of QoL and cardiovascular outcomes. Hypothesis: The use of a single anti-anginal (β-Blockers, calcium channel blockers, or nitrates) is non-inferior to ≥2 anti-anginals Methods: We utilized data from the BARI-2D trial, which compared cardiovascular and QoL outcomes in patients with SIHD and diabetes mellitus (DM) randomized to revascularization with intensive medical therapy or intensive medical therapy alone. We categorized patients into three groups: ≥2 vs 1 vs 0 anti-anginals. We compared patient characteristics, QoL metrics, and cardiovascular endpoints at baseline and at 5 years, creating a multivariable model to adjust for key clinical confounders. Results: Among 2,368 patients, 348 patients (14.7%) were on 0 anti-anginals, 1,020 patients (43.1%) were on 1 anti-anginal, and 1,000 patients (42.2%) were on ≥2 anti-anginals at baseline. The most common anti-anginal class was β-Blockers. At baseline, patients on 0 anti-anginals had better QoL metrics than patients on ≥2 anti-anginals. However, at a 1-year follow-up, patients taking only 1 anti-anginal showed greater QoL improvement than those taking 0 anti-anginal; this superiority in QoL metrics was not seen in patients taking ≥2 anti-anginal agent, even after adjusting for multiple covariates such as age, heart failure, diabetes control and myocardial jeopardy index. (Figure 1) Lastly, at 5-year follow-up, after adjustment, there were no differences in all-cause mortality, major adverse cardiovascular events, or myocardial infarction between patients taking different numbers of anti-anginals. Conclusion: Treating adults with SIHD and DM with a single anti-anginal was at least as effective in improving QoL compared to two or more anti-anginal agents at one year of follow-up.