Frequency Of Anginal Attacks Research Articles

THE ASSESSMENT OF NICORANDIL EFFECT ON THE QUALITY OF LIFE IN PATIENTS WITH STABLE ANGINA IN THE "KVAZAR" STUDY

Aim . To assess the effect of nicorandil added to the standard therapy of patients with stable ischemic heart disease (IHD) on the quality of life (QoL). Material and methods . Patients with verified IHD (stable angina; n=120) were included into double-blind, placebo-controlled, parallel group study. All patients in the study received metoprolol tartrate (100 mg daily). Nicorandil was added (10 mg BID, and then after 2 weeks 20 mg BID) to the treatment of patients of the main group. Placebo was added to treatment of patients in the control group. The study duration was 6 weeks. QoL was assessed by theSeattle questionnaire (SAQ) and visual analogue scale (VAS) at baseline and at the end of the study. Results . A significant decrease in the number of angina attacks was found in the nicorandil group compared to baseline [from 3.0 (2.0, 5.0) to 1.2 (0.7, 2.0); p<0.01] and compared to the placebo group [2.0 (1.0, 3.0); p=0.02]. The positive dynamics of QoL and functionality of patients with IHD was observed in the nicorandil group at the end of the study. It was demonstrated by significant improvement in all SAQ scales compared to baseline. Positive dynamics in the control group was found only in three scales (limitation of physical activity, frequency of angina attacks and patient attitude to the disease). VAS data revealed a significant increase in the integral index in patients of the main group (from 65.0±14.5 to 69.3±15.1; p=0.07), that was significantly higher than this in control group (64.6±15.1; p=0.02) at the end of the study. Conclusion . Nicorandil addition to the standard therapy of patients with IHD (stable angina) demonstrated improvement in the QoL, assessed by SAQ questionnaire and VAS.

ANTI-ISCHEMIC AND ANTIOXIDANT ACTIVITY OF MELDONIUM IN IHD PATIENTS WITH STABLE ANGINA

(IHD), stable angina of effort of functional class II (43 persons) – III (39 persons) (53.3±7.5 y.o., men - 71, women - 11), with concomitant arterial hypertension – in 21 patient. All patients received traditional anti-anginal disaggregation and hypolipidemic therapy. The therapy of patients of Group 1 was supplemented by meldonium (Mildronate®) at a dosage of 750 mg per day for 2 months. Patients of Group 2 continued to receive traditional therapy. After the period of wash-out (3 months) rotation of patients was done: meldonium was indicated to 750 mg/day for 2 months to a group of patients that previously didn’t receive meldonium previously. Materials and methods. Evaluation of physical tolerance by the cycle ergometer test; activity of free radical processes in the blood by the level of lipoperoxides degradation in blood – diene conjugate (DC), malondialdehyde (MDA). Results. Meldonium inclusion in the complex therapy was accompanied by increase of physical tolerance, reduction of DC and MDA levels in the blood, reduction of the frequency of angina attack and demand in sublingual nitrates. Conclusion. Application of Mildronate® in a composition of complex therapy of patients with stable angina allows increasing effectiveness of traditional anti-angina therapy.

Evaluation of Anti-Ischemic and Cardioprotective Effects of Nicorandil in Patients With Stable Angina

The aim of our study was to assess the anti-ischemic and cardiouprotective efficiency of the activator of potassium channels nicorandil in patients with stable angina during long-term intake on the background of standard therapy of coronary heart disease (CHD), including aspirin, rosuvastatin, valsartan and bisoprolol in comparison with standard therapy and long-acting form of nitrates. We compared the dynamics of nitroglycerine consumption, frequency of angina attacks, carried veloergometry, daily monitoring of an electrocardiogram by Holter, echocardiography, assess the state of lipid and carbohydrate metabolism, were determined concentrations of certain markers of systemic inflammation. The results showed that the inclusion of nicorandil into the standard therapy CHD leads to more significant changes in indicators of clinical evaluation of angina pectoris, myocardial remodeling, inflammatory markers.

A protocol of histone modification-based mechanistic study of acupuncture in patients with stable angina pectoris.

BackgroundAngina pectoris (Angina) is a medical condition related to myocardial ischemia. Although acupuncture has been widely accepted as a clinical approach for angina, there is no sufficient evidence of its effectiveness against this syndrome, and its mechanisms have not yet been well elucidated. We develop this protocol to confirm the clinical efficacy of electro-acupuncture on stable angina pectoris by needling on acupoint Neiguan (PC6). Furthermore, we employ high-throughput sequencing technology to investigate the gene expression profiling and determine involvement of histone modifications in the regulation of genes after electro-acupuncture treatment.Methods/DesignA randomized, controlled, double-blinded (assessor and patients) trial will be carried out. Sixty participants will be randomly assigned to two acupuncture treatment groups and one control group in a 1:1:1 ratio. Participants in acupuncture groups will receive 12 sessions of electro-acupuncture treatment across 4 weeks, followed by a 12-week randomization period. The acupuncture groups are divided into Neiguan (PC6) on Pericardium Meridian of Hand-jueyin or a non-acupoint. The primary clinical measure of effect is the frequency of angina attacks between these groups for four weeks after randomization. RNAs are extracted from peripheral neutrophils collected from all participants on day 0, day 30, and week 16, and are processed to RNA-Seq. We then investigate profiles of histone modifications by ChIP-Seq, for H3 Lysine 4 (H3K4me) and acetylation of H3 Lysine 27 (H3K27ac), in the presence or absence of acupuncture treatment.DiscussionThis study determines the efficacy and mechanisms of electro-acupuncture on stable angina pectoris. We focus on effectiveness of acupuncture on alleviating symptoms of myocardial ischemia and the gene regulation and the chromatin remodeling marks, including H3K4me1, H3K4me2, and H3K27ac, which could be key factors for regulating gene expressions caused by electro-acupuncture treatment at Neiguan. This is the first genome-wide study of electro-acupuncture treatment in angina patients, and will provide valuable information for future studies in the fields of acupuncture and its underlying mechanisms.Fourteen patients have been recruited since recruitment opened in November of 2012. This study is scheduled to end in November of 2014.Trials registrationChiCTR-TRC-12002668

Clinical and Economic Efficacy of Ivabradine in Patients Suffered Myocardial Infarction

to assess the clinical and cost-effectiveness of the addition to the treatment of patients with coronary artery disease, myocardial infarction (MI) If current blocker ivabradine. as a basis for pharmacoeconomic research results of the program are taken battleships, in which 1226 patients with MI less than 12 months ago, for 16 weeks received ivabradine in addition to standard therapy. When conducting pharmacoeconomic calculations take into account the direct medical and non-medical costs of treating patients with drugs; the call ambulance crews (CAC); on the patients stay in the hospital at admission. To determine the cost of use of ivabradine used data on daily dosages of the drug presented in the program battleships. In this case, using the retail price of drugs taken from the resource pharmindex.ru (date accessed 6/23/14). When calculating the cost of hospitalization and emergency calls using the values specified in the decree of october 18, 2013 No932 "About the state guarantees the free provision of medical care to citizens for 2014 and the planning period of 2015 and 2016.". according to a study LINCOR adding ivabradine to standard therapy resulted in a significant reduction in the frequency of angina attacks, the need for treatment for CACs and hospitalization. Average total cost of a full 16-week course of therapy with a patient ivabradine 1.87 times lower than with the standard therapy alone. The most obvious benefits to health care institutions: the total cost of emergency calls and hospitalization when added to treatment with ivabradine reduced 20 027.79 to 1,630.45 rubles., Ie 12.3 times. despite the increase in direct costs due to the cost of the drug, the addition to the standard therapy of ivabradine in patients with myocardial infarction, pharmaco is more effective than using only standard therapy, due to a significant reduction in the need for emergency calls and hospitalization.

Сравнительная оценка влияния изосорбида динитрата, изосорбида-5-мононитрата и никорандила на частоту приступов стенокардии и вазорегулирующую функцию эндотелия у больных ишемической болезнью сердца

to compare effects of isosorbide dinitrate, isosorbide-5-mononitrate and nicorandil on frequency of angina attacks and vasoregulating endothelial function in patients with ischemic heart disease (IHD). MATERIAL AND METHODS. In 117 patients with stable II-III functional class angina we analyzed frequency of angina attacks, exercise tolerance, data of 24-hour Holter ECG monitoring and brachial artery Doppler study. RESULTS. Patients with IHD had impaired endothelium-dependent vasodilation in the form of reduced endothelial response to increase of "shear stress" during test with reactive hyperemia. Long-term therapy with isosorbide dinitrate, isosorbide-5-mononitrate, and nicorandil was associated with normalization of endothelium-dependent vasodilation of the brachial artery. This effect was more pronounced during therapy with nicorandil.

Efficacy and Safety of Huxin Formula in Patients after CABG: A Multicenter, Double-Blind, Randomized Clinical Trial

Background: Coronary artery bypass grafting (CABG) is widely used in the treatment of coronary artery disease. A multicenter, double-blind, randomized, controlled clinical trial was designed to evaluate the efficacy and safety of Huxin Formula post CABG. Patients and Methods: 270 inpatients with coronary heart disease participated in this study. CABG patients in the control group were treated with placebo, while patients in the experimental group were treated with Huxin Formula 1 week after the surgery. All patients were treated for 6 months and followed up for another 6 months. The main outcomes (death, nonfatal myocardial infarction, repeat revascularization, and readmission) were assessed 360 days after treatment, and secondary outcomes (frequency and scores of angina pectoris, etc.) were assessed 0, 90, 180, 270, and 360 days after treatment. Results: Our results showed no significant difference between the 2 groups for the primary endpoints. In patients with cardiac function class II (New York Heart Association), the score of angina pectoris was significantly lower (3.88 ± 3.86 vs. 5.45 ± 3.59) and the frequency of angina pectoris attacks was less (0.96 ± 1.01 vs. 1.36 ± 0.94) after 90 days of treatment with Huxin Formula compared to placebo (p < 0.05). In patients with 3 coronary vessel lesions, the cardiac function class (1.14 ± 0.35 vs. 1.05 ± 0.21) after 360 days was significantly higher in the control group compared to the treatment group (p < 0.05). There were no obvious adverse reactions. Conclusion: Huxin Formula may improve cardiac function of patients with 3 coronary vessel lesions and relieve symptoms of patients with cardiac function class II but failed to show superiority in primary outcomes.

Meta-analysis on the randomized controlled trials of Fufang-Danshen injection in the treatment of unstable angina pectoris

Objective To systematically evaluate the clinical efficacy and safety of Fufang-Danshen Injection （FD） in the treatment of unstable angina pectoris（UAP）. Methods Randomized controlled trials （RCTs） and quasi-RCTs regarding FD in the treatment of UAP were collected through comprehensive searches of China National Knowledge Infrastructure（CNKI）, Chinese Scientific Journals Database（VIP）, Wan fang Database, Chinese Biomedical Literature Database（CBM）, PubMed, Embase and Cochrane Library from January 1979 to December 2013. Two reviewers independently assessed the quality of the included studies by the Cochrane risk of bias, and extracted the information from the included studies. Meta-analysis was conducted with the software Review Manager 5.2. Results A total of 13 studies with 1156 participants were included. In the meta-analysis, ①the total effective rate of UAP：in term of FD＋conventional therapy with western medicine（WM）vsWM, the difference between two groups was statistically significant [RR=1.32, 95%CI（1.21, 1.43）, P〈0.01]; FD＋low molecular weight heparin＋WM vs WM, difference between two groups was also statistically significant [RR=1.29, 95% CI（1.17, 1.42）, P〈0.01], which indicated that the efficacy of experimental group was higher than the control group. Other interventions, such as FD＋WM vs low＆amp;nbsp;molecular weight heparin＋WM and FD vs WM, there was no significant difference between two groups. ②the total effective rate of ECG：in term of FD＋WM vs WM, the difference between two groups was statistically significant [RR=1.34, 95%CI （1.14, 1.57）, P〈0.01]; in term of FD vs WM, difference between two groups was statistically significant [RR=1.49, 95%CI（1.13, 1.96）, P〈0.01], which indicated that experimental group can effectively improve the total effective rate of ECG. ③ frequency of angina attacks：in term of FD＋WM vs WM, the difference between two groups was statistically significant [MD=1.07, 95%CI（0.48, 1.66）, P〈0.01]. No differences between groups existed in other analysis. ④ adverse drug reactions（ADRs）：4 articles cleared that there was no ADRs in the studies, 4 studies reported ADRs, which represented headache, nausea, flushing and so on. There were 9 cases in the experimental group, and 9 in control group. Conclusion Based on the meta-analysis, FD was effective and relatively safe for the treatment of UAP in clinical. However, since the articles enrolled in the study were not in high quality, more qualified studies should be conducted for the further assessment of efficacy and safety of FD for UAP. Key words: Fufang-Danshen injection; Unstable angina pectoris; Randomized controlled trials; Systemic review

Interrelation between the content of magnesium in the blood of the strain stenocardia patients of different temperament and anxiety and tension degree of the Earth magnetic field

During the magnetic storms magnesium content decreases and frequency of angina pectoris attacks increases minimally in the lowanxiety cholerics and maximally in the highanxiety melancholics and phlegmatics. The latter are the groups at risk of developing complications of coronary heart disease.

Frequency of angina and quality of life in outpatients with stable coronary artery disease in Turkey: insights from the PULSE study

Objective Cardiologists’ approach to angina in outpatients with stable coronary artery disease (CAD) is unclear. Therefore, we analysed data from the national multicentre, observational PULSE study to evaluate the frequency of angina, clinical variables affecting angina frequency and the impact of frequent angina on quality of life (QoL) in outpatients with stable CAD managed by cardiologists in secondary and tertiary health-care centres in Turkey.Methods and results Adult outpatients with stable CAD in sinus rhythm were included. Data were collected at a single study visit from 83 centres. Patients were divided into five categories according to angina attack frequency. QoL was measured by the MacNew heart disease health-related QoL Questionnaire. The mean (standard deviation; SD) age of all patients (n = 2661) was 61.2 (10.2) years. Of 2,661 patients, 48.7% had no anginal attacks while 16.5% had minimal, 14.5% occasional, 12.2% regular and 8.1% frequent attacks. Angina attack frequency correlated positively with female sex, heart rate, the severity of angina. Emotional, physical, social, and global scores of QoL tended to decrease across angina attack frequency categories. Short- and long-acting nitrates, ivabradine were significantly more preferred in patients with higher frequency of angina attacks rather than beta blockers and calcium channel blockers.Conclusions Insufficient angina control in outpatients with stable CAD requires reassessment of medical approach since it has a negative impact on QoL. The social and economic consequences of this burden should be sought on a national basis.

Effect of atorvastatin combined with clopidogrel in the treatment of elderly patients with angina pectoris

Objective To investigate the efficacy and safety of atorvastatin combined with clopidogrel in the treatment of elderly patients with angina pectoris.Methods 90 elderly patients with angina pectoris were randomly divided into the observation group and control group,45 cases in each group.All patients were given conventional treatment and atorvastatin,the observation group was given clopidogrel based on this.The TC,TG,HDL-C,LDL-C,angina attack frequency,duration and adverse reactions,adverse cardiac events of two groups before and after treatment were compared,and the clinical effect was evaluated.Results The total effective rate of the observation group was 9 3.3 ％ (42/45),whichwassignificantlyhigherthan75.6％ (34/45) inthecontrolgroup (x2 =5.67,P ＜ 0.05).After treatment,the TC,TG,HDL-C,LDL-C of two groups were significantly improved than before treatment (t =5.34,4.78,4.56,4.92,4.31,3.92,4.11,4.62,all P ＜ 0.05),the improvement in the observation group was significantly better than that in the control group (t =4.20,4.08,3.98,4.03,all P ＜ 0.05).After treatment,the angina attack frequency and duration of two groups were significantly decreased compared with before treatment (t =6.22,5.78,4.12,4.02,all P ＜ 0.05),and the observation group decreased significantly than the control group(t =4.23,3.99,all P ＜ 0.05).3 cases of adverse reactions and 1 case of adverse cardiac events occurred in observation group,2 cases of adverse reaction and 3 cases of adverse cardiac events occurred in control group.Conclusion Atorvastatin combined with clopidogrel in the treatment of elderly patients with angina pectoris can regulate blood lipid and improve the symptoms of angina pectoris. Key words: Angina pectoris ; Atorvastatin; Clopidogrel ; Aged

Acupuncture for chronic, stable angina pectoris and an investigation of the characteristics of acupoint specificity: study protocol for a multicenter randomized controlled trial.

BackgroundChronic stable angina pectoris (CSAP) is a common cardiovascular condition that endangers a patient’s life quality and longevity. As demonstrated in several clinical trials, acupuncture is attested to be effective for CSAP. Current trials are not adequate enough to provide high-quality evidence for clinical decision making, as a result of inadequate methodology design and small sample size. Notably, stark controversy toward acupoint specificity also exists in the clinical acupuncture trials for CSAP. Therefore, we designed the present study as a randomized controlled trial primarily to investigate the effectiveness of acupuncture in addition to routine care among patients with CSAP. Meanwhile, we examined whether acupoint on the disease-affected meridian (DAM) is superior to either acupoint on the non-affected meridian (NAM) or non-acupoint (NA), to further investigate the meridian-based characteristics of acupoint specificity.Methods/DesignThis study was a multicenter, assessor and statistician blinded, randomized controlled trial in China. In this study, 404 participants in sum will be randomly assigned to four groups through central randomization in a 1:1:1:1 ratio. The whole study period is 20 weeks including a 4-week baseline period, a 4-week treatment period and a 12-week follow-up. Participants in the DAM group receive acupuncture stimulation at acupoints on the disease-affected meridian, and three different control groups will undergo acupuncture stimulation at the NAM, the non-acupoint and no intervention respectively, in addition to basic treatment. Participants in the acupuncture groups will receive 12 sessions of acupuncture treatment over 4 weeks, while the wait-listed (WL) group would receive free acupuncture treatment after the completion of the study. The outcome measures in this trial include the frequency of angina attack during 4 weeks as the primary outcome and eight other secondary outcomes.DiscussionThis trial will provide new and relatively high-quality evidence in acupuncture treatment for CSAP. Moreover, this trial may further validate the meridian-based characteristics of acupoint specificity by comparing the strength of acupoints on the disease-affected meridian versus that of the non-affected meridian, to further inspire optimization of acupuncture therapy for CSAP.Trial registrationClinical Trials.gov NCT01686230

Acupoint application in patients with chronic stable angina pectoris: study protocol of a randomized, double-blind, controlled trial.

Background. Chronic stable angina pectoris (CSAP) is a major syndrome of ischemic heart disease (IHD). CSAP manifests as chest pain or discomfort and affects patients' quality of life. Acupoint application (AP) has been reported to be effective for managing the symptoms of CSAP, but the evidence is not convincing. Therefore, we designed a randomized, double-blind, placebo-controlled clinical trial to evaluate the efficacy of AP in the treatment of CSAP. Methods and Analysis. Two hundred participants with CSAP will be randomly assigned in a 1 : 1 : 1 : 1 ratio into 4 groups. All participants will receive 12 sessions of treatment in 4 weeks and the same basic treatment procedure. The participants will be visited and assessed for 12 weeks, including a 4-week screening, a 4-week treatment phase, and a 4-week follow-up phase. The primary outcome is the change in the total frequency of self-reported angina attack at 4th week compared with the baseline. The secondary outcomes include the intensity of angina pain, consumption of nitroglycerin or Suxiao Jiuxin pills, CCS angina classification, SAQ, SAS and SDS score. Ethics. The study protocol has been reviewed and approved by the Sichuan Regional Ethics Review Committee on TCM (number 2013kl-001). This trial is registered with clinicaltrials.gov NCT02029118.

Comparative Short-Term Effect of Once-Daily Molsidomine on Chronic Angina in General Practitioners’ versus Cardiologists’ Coronary Patient Populations

The direct nitric oxide donor molsidomine is commonly used to relieve symptoms in chronic angina thanks to its vasodilatory properties that induce both a reduction in myocardial oxygen demand and an increase in coronary blood flow. The objective of this study was to compare the short-term effect of molsidomine 16mg once daily (Coruno(®), Therabel Pharmaceuticals Ltd, Dublin, Ireland) in patients with stable angina previously on molsidomine 8mg twice daily, in care of general practitioners (GPs) versus cardiologists. A total of 53 and 80 patients treated by GPs and cardiologists, respectively, took part in this multicenter, open-label clinical trial. Frequency of anginal attacks, short-acting nitroderivative tablets consumption, and subjective clinical status were evaluated, as was tolerability to molsidomine through the reporting of adverse events (AEs), the recording of vital parameters-resting blood pressure, heart rate, and electrocardiogram-and routine blood analyses. Although demographic and clinical characteristics were significantly different in GPs' compared with cardiologists' patients, the effect of either the 8mg or the 16mg molsidomine formulation on anginal crises and nitroderivatives consumption was similar in both patient cohorts, with a trend for the 16mg formulation to be more efficient on symptoms in elderly patients. Subjective assessment of the beneficial effect of molsidomine 16 versus 8mg was comparable in GPs' and cardiologists' patients independently of age, "no change" being the most often reported item. Self-evaluation of functional capacity in elderly showed on the whole no difference between the two patient cohorts, only magnitude of pace and total score on molsidomine 16mg being higher in cardiologists' compared with GPs' patients, and total score in cardiologists' patients higher on molsidomine 16mg compared with 8mg. Incidences of AEs and drug-related AEs, as well as proportions of patients reporting such AEs, were similar between GPs' and cardiologists' patient cohorts as between molsidomine 8 and 16mg formulations. Molsidomine 16mg once daily had no clinically significant effect on blood pressure, heart rate, electrocardiogram or blood parameters, and compliance with treatment was excellent in whatever patient cohort. Despite significant demographic and clinical differences between patients in care of GPs and cardiologists, molsidomine was equally efficient in these two patient cohorts, with a trend towards less anginal attacks in the elderly when treated with the 16mg compared with the 8mg formulation. Compliance and tolerability to the drug were excellent in both patient cohorts.

Efficacy of Cilostazol on Uncontrolled Coronary Vasospastic Angina: A Pilot Study

BackgroundAlthough an angina attack by vasospastic angina (VSA) can usually be relieved or controlled with nitrates and calcium channel blockers (CCBs), there are some patients who cannot be controlled even by higher doses and combinations of these drugs. Cilostazol is a selective inhibitor of phosphodiesterase 3 that increases intracellular cyclic adenosine monophosphate (cAMP) contents. A stimulation of cAMP signal transduction increases coronary nitric oxide production. We examined whether cilostazol improved angina symptoms in patients with VSA uncontrolled by conventional treatment.MethodsThis study was conducted in a prospective, multicenter, nonrandomized manner. The subject consisted of 21 patients (13 men, 57 ± 9 year-old) who were diagnosed with VSA and had at least two angina attacks during the past 1 week despite of conventional medications such as CCBs and/or nitrates. They took cilostazol 100 mg twice daily for 2 weeks in addition to the conventional medications. The patients recorded the frequency of angina attack and wrote down the numeric rating scale of a "severity of angina attack" while taking conventional medications and cilostazol for 2 weeks, and also recorded an averaged scale or total number of event during the last week at the time of the assessment. Using the Wilcoxon rank-sum test, we compared the changes in the scores of frequency and severity of angina attack before and after adding cilostazol to the conventional medications.ResultsAfter adding cilostazol to the conventional medications, there were 78.9% relative reduction of the score of angina intensity and 73.5% of angina frequency (P < 0.001). There were four patients (19%) who were forced to stop cilostazol due to headache as an adverse event.ConclusionsCilostazol appears to be an effective therapy in VSA uncontrolled with conventional medical treatment. A further prospective, randomized, placebo-controlled study will be needed to validate this result.

Comparison of the efficacy and tolerability of ivabradine and ranolazine in patients of chronic stable angina pectoris

Introduction:To compare the efficacy and tolerability of Ivabradine (IVA) and Ranolazine (RAN) in chronic angina patients.Materials and Methods:This was a follow-on, open-label trial conducted in a tertiary care hospital of Uttarakhand. Thirty patients each taking IVA 5 mg twice daily or RAN 500 mg twice daily were distributed to the respective groups. Patients were asked to fill a pretested questionnaire on frequency of anginal attacks and adverse reactions before and 2, 4 and 8 weeks after taking the respective medicines. Their blood pressure, heart rate and routine hematological and biochemical estimations were performed at baseline and after intervention. Results were statistically analyzed using different statistical tests, with P < 0.05 considered as significant.Results:There was no significant difference in the frequency of anginal attacks per week between the groups. The adverse drug reactions (ADRs) reported in the IVA group were dizziness (30%), headache (16.6%), backache (16.6%), vertigo (13.3%), blurred vision (13.3%), muscle cramps (10%), arthralgia (10%), cough and dyspnea (6.6%), hypersensitivity rash (6.6%), fever (3.3%) and nausea (3.3%). The ADRs in the RAN group were nausea (26.6%), dizziness (23.3%), vomiting (3.3%), constipation (3.3%) and vertigo (3.3%). The blood pressure, heart rate and routine hematological and biochemical evaluations did not show any significant difference in the pre–post values. IVA significantly decreased the resting heart rate after eight weeks of intervention.Conclusions:Both antianginal agents appeared equiactive. However, RAN had a better safety and tolerability profile than IVA. Serum sickness-like reaction was an adverse event noticed with IVA, which needs causality establishment.

The effectiveness and cost-effectiveness of spinal cord stimulation for refractory angina (RASCAL study): study protocol for a pilot randomized controlled trial.

BackgroundThe RASCAL (Refractory Angina Spinal Cord stimulation and usuAL care) pilot study seeks to assess the feasibility of a definitive trial to assess if addition of spinal cord stimulation (SCS) to usual care is clinically superior and more cost-effective than usual care alone in patients with refractory angina.Methods/designThis is an external pilot, patient-randomized controlled trial.The study will take place at three centers in the United Kingdom - South Tees Hospitals NHS Foundation Trust (The James Cook University Hospital), Dudley Group of Hospitals NHS Foundation Trust, and Basildon and Thurrock University Hospitals NHS Foundation Trust.The subjects will be 45 adults with refractory angina, that is, limiting angina despite optimal anti-angina therapy, Canadian Cardiovascular Society Functional Classification Class III and IV, angiographically documented coronary artery disease not suitable for revascularization, satisfactory multidisciplinary assessment and demonstrable ischemia on functional testing.The study will be stratified by center, age and Canadian Cardiovascular Society Functional Classification.Interventions will involve spinal cord stimulation plus usual care (‘SCS group’) or usual care alone (‘UC group’). Usual care received by both groups will include consideration of an education session with a pain consultant, trial of a transcutaneous electrical neurostimulation, serial thoracic sympathectomy and oral/systemic analgesics.Expected outcomes will be recruitment and retention rates; reasons for agreeing/declining participation; variability in primary and secondary outcomes (to inform power calculations for a definitive trial); and completion rates of outcome measures. Trial patient-related outcomes include disease-specific and generic health-related quality of life, angina exercise capacity, intake of angina medications, frequency of angina attacks, complications and adverse events, and satisfaction.DiscussionThe RASCAL pilot trial seeks to determine the feasibility and design of a definitive randomized controlled trial comparing the addition of spinal cord stimulation to usual care versus usual care alone for patients with refractory angina.Fifteen patients have been recruited since recruitment opened in October 2011. The trial was originally scheduled to end in April 2013 but due to slow recruitment may have to be extended to late 2013.Trial registrationISRCTN65254102

The analysis of the effect of the joint method containing salvia tetramethylpyrazine,trimetazidine, alprostadil in the treatment of unstable angina

Objective To evaluate the feasibility of the joint method containing salvia tetramethylpyrazine,trimetazidine,alprostadil in the treatment of unstable angina.Methods 70 unstable angina patients met the inclusion criteria were randomly divided into the observation group of 35 cases and the control group of 35 cases.The control group was given trimetazidine 20mg,tid,and alprostadil 100mg,1 qd.The observation group were given salvia tetramethylpyrazine 10ml on the basis of the control group,qd.Two groups were treated for 14d.The frequency and duration of angina attack was observed.The ECG was monitored.Clinical efficacy differences was compared before and after treatment.Results The total effective rate of the observation group was 100％.The effective rate were 86％.The control group were respectively 91％ and 60％.The total effective rate of observation group was significantly higher than the control group(x2 =6.838,P ＜ 0.05).The effective rate of observation group was significantly higher than the control group (x2 =5.851,P ＜ 0.0 5).The angina frequency,angina duration,stroke output quantity (SV),eiectionfraction(EF) of the observation group and the control group after treatment improved significantly than before treatment,after the treatment the angina frequency,angina duration,stroke output quantity (SV),ejection fraction (EF) of the observation group and the control group were respectively (2.69 ± 0.46) time/min vs (6.46 ± 0.62) time/min,(3.26 ± 0.32) min vs (5.54 ± 0.42) min,(49.7 ± 3.4) ml vs (43.2 ± 2.8) ml,(69.2 ± 5.9) ％ vs (55.3 ±4.8) ％,the angina frequency,angina duration of the observation group was significantly lower than the control group,and the stroke output quantity(SV),ejection fraction(EF) of the observation group were significantly higher than the control group(all P ＜ 0.05).Condusion The joint method containing salvia tetramethylpyrazine,trimetazidine,alprostadil have exact clinical efficacy,reduce the time of angina attack frequency and duration,effectively improve myocardial blood supply,improve heart function,which is worthy of clinical use. Key words: Salvia tetramethylpyrazine; Trimetazidine; Alprostadil ; Angina, unstable

Xuesaitong Soft Capsule (Chinese Patent Medicine) for the Treatment of Unstable Angina Pectoris: A Meta-Analysis and Systematic Review

Objective. To provide a systematic review to evaluate the effectiveness and safety of Xuesaitong soft capsule (XST) in treating unstable angina (UA). Methods. An extensive search of 6 medical databases was performed up to August 2013. Randomized controlled trials (RCTs) involving XST alone or combined with conventional drugs versus conventional drugs were included. A meta-analysis of reduction of angina symptoms and electrocardiogram (ECG) improvement was performed to evaluate the effects of XST on UA. Results. After researching, a total of 6 RCTs with 716 participants were included. Our review showed that XST combined with conventional drugs had significant effect on relieving angina symptoms (RR: 1.14 [1.07, 1.22]; P = 0.0001) and improving ECG (RR: 1.26 [1.12, 1.42]; P = 0.0001) compared with conventional drugs alone. Conclusions. XST appears to have beneficial effects on improvement of ECG, reduction of angina symptoms, and decreasing the frequency and duration of angina attack in participants with UA. However, the findings should be interpreted with caution due to the poor methodological quality of the included trials.

Abstract 9574: Enhanced Rho-kinase Activity in Circulating Neutrophils of Patients with Vasospastic Angina after the Great East Japan Earthquake

Purpose: We have recently demonstrated that Rho-kinase activity in circulating neutrophils is a useful biomarker for diagnosis and disease activity assessment of vasospastic angina (VSA). Coronary vasospastic activity is known to be enhanced under stressful conditions. On March 11, 2011, we experienced the Great East Japan Earthquake in our Tohoku area. In this study, we thus examined whether Rho-kinase activity was increased in VSA patients after the Earthquake. Methods: In 11 patients with proven VSA (M/F 8/3, 62±11 yrs), we were able to measure Rho-kinase activity in circulating neutrophils at 3 time points, before and 6 and 12 months after the Earthquake. Rho-kinase activity was defined by the ratio of phosphorylated form/total form of myosin-binding subunit (MBS), a substrate of Rho-kinase. We also quantitatively examined the extent of mental stress by the post-traumatic stress disorder (PTSD) questionnaire. Results: In the VSA patients, Rho-kinase activity was significantly increased at 6 months after the Earthquake despite the continued medical treatment with calcium channel blockers, which was returned to baseline level at 12 months (0.99±0.34 at baseline, 1.71±0.23 at 6 months, and 0.90±0.34 at 12 months) ( Figure ). Among the 11 patients, 3 patients were directly hit by the Tsunami, who complained increased frequency of angina attacks and the use of sublingual nitroglycerin after the Earthquake. Importantly, in those 3 patients, as compared with the remaining 8 patients without direct tsunami hit or changes in symptoms, both PTSD score (32±7 vs. 5±8, P=0.01) and the changes in Rho-kinase activity at 6 months from the baseline (268±232% vs. 55±40%, P&lt;0.05) were significantly higher. Furthermore, there was a significant correlation between the Rho-kinase activity changes and the PTSD score (r= 0.67, P&lt;0.05). Conclusions: These results indicate that Rho-kinase activity of VSA patients was transiently enhanced by the disaster-related mental stress.