Isolated stable angina due to coronary heart disease

Poole-Wilson PA, Voko Z, Kirwan BA et al for the ACTION investigators. Eur Heart J 2007 Jun 11 (Epub ahead of print)

The availability of therapeutic interventions whose benefits are already established may make it difficult to measure the natural course of untreated disease in the modern setting.

This study describes an analysis of outcomes in patients with stable symptomatic angina, with no history of coronary intervention or major cardiovascular events.

The investigators studied a subgroup of a randomised controlled trial of long-acting nifedipine (ACTION). As this relied on subgroup data drawn from a trial, the patients studied were subject to the trial's exclusion and inclusion criteria, and were therefore not necessarily representative of the overall population with stable symptomatic angina.

Nevertheless, this study has led to the creation of the ACTION database, the largest such database recording outcomes for stable symptomatic angina. A risk algorithm for predicting outcomes in this group has been developed and published elsewhere. The study's findings demonstrated that such patients generally have a good prognosis, but may suffer major cardiovascular events, or death without significant warning signs (such as hospital admission with chest pain). The implication is that effective preventive interventions (such as coronary revascularisation) should be offered to all such patients, rather than favouring above-average risk groups, or waiting for such warnings to develop.

- Dr Tim Holt is a GP and clinical lecturer, University of Warwick

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