Applying a metaanalysis, it was examined whether a combination of drugs is superior to monotherapy in the treatment of
angina pectoris. The three classical groups of anti-anginal drugs,
nitrates,
calcium channel blockers and beta-receptor blockers were investigated. For data analysis, patients were divided in those suffering from "
angina pectoris" and those suffering from "
angina pectoris despite monotherapy." In patients with the inclusion criterium "
angina pectoris" combination of drugs is not superior to monotherapy. This applies to the evaluation criteria "improvement of symptoms" and "reduction of
ischemia". In patients with the inclusion criterium "
angina pectoris despite monotherapy" however, there is a clear superiority of
drug combination as compared to monotherapy. Again this applies to the evaluation criteria "improvement of symptoms" and "reduction in
myocardial ischemia". With respect to antianginal efficacy all three possible combinations appear to be similar. If the evaluation criterium is "improvement of prognosis" no data are available with regard to
drug combination. Furthermore no data are available on the prognostic effect of an anti-anginal
therapy in patients with
stable angina pectoris. A significant improvement of prognosis could be demonstrated for beta-receptor blocking agents without ISA in
unstable angina, acute
myocardial infarction, and in the postinfarction period. The effect of
calcium channel blockers on prognosis depends on the substance class applied and on the presence or absence of signs of
congestive heart failure. Monotherapy with
nifedipine in instable angina and acute
myocardial infarction fails to improve prognosis, and there even may be a tendency to adverse effects. In the absence of signs of
congestive heart failure verapamil has been demonstrated to improve prognosis in the post
infarction period. Likewise, improvement of prognosis by the administration of
diltiazem in acute
myocardial infarction only could be demonstrated in patients without signs of
heart failure. In contrast, in patients with signs of
congestive heart failure diltiazem increased the rate of reinfarction and mortality. For
nitrates only in acute
myocardial infarction a trend towards improved prognosis has been shown. Especially for
nitrates the data on prognosis in
coronary heart disease available so far are not convincing.