Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION trial): randomised controlled trial
Calcium antagonists are widely prescribed for angina pectoris but their effect on clinical outcome is controversial. We aimed to investigate the effect of the calcium antagonist nifedipine on long-term outcome in patients with stable angina pectoris. We randomly assigned 3825 patients with treated s...
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| Veröffentlicht in: | The Lancet (British edition) 2004-09, Vol.364 (9437), p.849-857 |
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| creator | Poole-Wilson, Philip A Lubsen, Jacobus Kirwan, Bridget-Anne van Dalen, Fred J Wagener, Gilbert Danchin, Nicolas Just, Hanjörg Fox, Keith AA Pocock, Stuart J Clayton, Tim C Motro, Michael Parker, John D Bourassa, Martial G Dart, Anthony M Hildebrandt, Per Hjalmarson, Åke Kragten, Johannes A Molhoek, G Peter Otterstad, Jan-Erik Seabra-Gomes, Ricardo Soler-Soler, Jordi Weber, Simon |
| description | Calcium antagonists are widely prescribed for angina pectoris but their effect on clinical outcome is controversial. We aimed to investigate the effect of the calcium antagonist nifedipine on long-term outcome in patients with stable angina pectoris.
We randomly assigned 3825 patients with treated stable symptomatic coronary disease to double-blind addition of nifedipine GITS (gastrointestinal therapeutic system) 60 mg once daily and 3840 to placebo. The primary endpoint was the combination of death, acute myocardial infarction, refractory angina, new overt heart failure, debilitating stroke, and peripheral revascularisation. Mean follow-up was 4·9 years (SD 1·1). Analysis was by intention to treat.
310 patients allocated nifedipine died (1.64 per 100 patient-years) compared with 291 people allocated placebo (1·53 per 100 patient-years; hazard ratio 1·07 [95% CI 0·91–1·25], p=0·41). Primary endpoint rates were 4·60 per 100 patient-years for nifedipine and 4·75 per 100 patient-years for placebo (0·97 [0·88–1·07], p=0·54). With nifedipine, rate of death and any cardiovascular event or procedure was 9·32 per 100 patient-years versus 10·50 per 100 patient-years for placebo (0·89 [0·83–0·95], p=0·0012). The difference was mainly attributable to a reduction in the need for coronary angiography and interventions in patients assigned nifedipine, despite an increase in peripheral revascularisation. Nifedipine had no effect on the rate of myocardial infarction.
Addition of nifedipine GITS to conventional treatment of angina pectoris has no effect on major cardiovascular event-free survival. Nifedipine GITS is safe and reduces the need for coronary angiography and interventions.
Published online August 31, 2004
http://image.thelancet.com/extras/04art6402web.pdf |
| doi_str_mv | 10.1016/S0140-6736(04)16980-8 |
| format | Article |
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We randomly assigned 3825 patients with treated stable symptomatic coronary disease to double-blind addition of nifedipine GITS (gastrointestinal therapeutic system) 60 mg once daily and 3840 to placebo. The primary endpoint was the combination of death, acute myocardial infarction, refractory angina, new overt heart failure, debilitating stroke, and peripheral revascularisation. Mean follow-up was 4·9 years (SD 1·1). Analysis was by intention to treat.
310 patients allocated nifedipine died (1.64 per 100 patient-years) compared with 291 people allocated placebo (1·53 per 100 patient-years; hazard ratio 1·07 [95% CI 0·91–1·25], p=0·41). Primary endpoint rates were 4·60 per 100 patient-years for nifedipine and 4·75 per 100 patient-years for placebo (0·97 [0·88–1·07], p=0·54). With nifedipine, rate of death and any cardiovascular event or procedure was 9·32 per 100 patient-years versus 10·50 per 100 patient-years for placebo (0·89 [0·83–0·95], p=0·0012). The difference was mainly attributable to a reduction in the need for coronary angiography and interventions in patients assigned nifedipine, despite an increase in peripheral revascularisation. Nifedipine had no effect on the rate of myocardial infarction.
Addition of nifedipine GITS to conventional treatment of angina pectoris has no effect on major cardiovascular event-free survival. Nifedipine GITS is safe and reduces the need for coronary angiography and interventions.
Published online August 31, 2004
http://image.thelancet.com/extras/04art6402web.pdf</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(04)16980-8</identifier><identifier>PMID: 15351192</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Angina pectoris ; Angina Pectoris - drug therapy ; Calcium ; Calcium Channel Blockers - therapeutic use ; Cardiovascular Diseases - mortality ; Cardiovascular Diseases - prevention & control ; Clinical trials ; Double-Blind Method ; Drugs ; Endpoint Determination ; Female ; Humans ; Male ; Medical treatment ; Middle Aged ; Morbidity ; Mortality ; Myocardial infarction ; Nifedipine - therapeutic use ; Survival Analysis</subject><ispartof>The Lancet (British edition), 2004-09, Vol.364 (9437), p.849-857</ispartof><rights>2004 Elsevier Ltd</rights><rights>Copyright Lancet Ltd. Sep 4-Sep 10, 2004</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c388t-7fb1fb154707aadff1cbe726b202de8c074b3fcbddc15f4c85c520baaa48a5c63</citedby><cites>FETCH-LOGICAL-c388t-7fb1fb154707aadff1cbe726b202de8c074b3fcbddc15f4c85c520baaa48a5c63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0140673604169808$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65534</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15351192$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Poole-Wilson, Philip A</creatorcontrib><creatorcontrib>Lubsen, Jacobus</creatorcontrib><creatorcontrib>Kirwan, Bridget-Anne</creatorcontrib><creatorcontrib>van Dalen, Fred J</creatorcontrib><creatorcontrib>Wagener, Gilbert</creatorcontrib><creatorcontrib>Danchin, Nicolas</creatorcontrib><creatorcontrib>Just, Hanjörg</creatorcontrib><creatorcontrib>Fox, Keith AA</creatorcontrib><creatorcontrib>Pocock, Stuart J</creatorcontrib><creatorcontrib>Clayton, Tim C</creatorcontrib><creatorcontrib>Motro, Michael</creatorcontrib><creatorcontrib>Parker, John D</creatorcontrib><creatorcontrib>Bourassa, Martial G</creatorcontrib><creatorcontrib>Dart, Anthony M</creatorcontrib><creatorcontrib>Hildebrandt, Per</creatorcontrib><creatorcontrib>Hjalmarson, Åke</creatorcontrib><creatorcontrib>Kragten, Johannes A</creatorcontrib><creatorcontrib>Molhoek, G Peter</creatorcontrib><creatorcontrib>Otterstad, Jan-Erik</creatorcontrib><creatorcontrib>Seabra-Gomes, Ricardo</creatorcontrib><creatorcontrib>Soler-Soler, Jordi</creatorcontrib><creatorcontrib>Weber, Simon</creatorcontrib><creatorcontrib>on behalf of the ACTION (A Coronary disease Trial Investigating Outcome with Nifedipine gastrointestinal therapeutic system) investigators</creatorcontrib><creatorcontrib>Coronary disease Trial Investigating Outcome with Nifedipine gastrointestinal therapeutic system investigators</creatorcontrib><title>Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION trial): randomised controlled trial</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Calcium antagonists are widely prescribed for angina pectoris but their effect on clinical outcome is controversial. We aimed to investigate the effect of the calcium antagonist nifedipine on long-term outcome in patients with stable angina pectoris.
We randomly assigned 3825 patients with treated stable symptomatic coronary disease to double-blind addition of nifedipine GITS (gastrointestinal therapeutic system) 60 mg once daily and 3840 to placebo. The primary endpoint was the combination of death, acute myocardial infarction, refractory angina, new overt heart failure, debilitating stroke, and peripheral revascularisation. Mean follow-up was 4·9 years (SD 1·1). Analysis was by intention to treat.
310 patients allocated nifedipine died (1.64 per 100 patient-years) compared with 291 people allocated placebo (1·53 per 100 patient-years; hazard ratio 1·07 [95% CI 0·91–1·25], p=0·41). Primary endpoint rates were 4·60 per 100 patient-years for nifedipine and 4·75 per 100 patient-years for placebo (0·97 [0·88–1·07], p=0·54). With nifedipine, rate of death and any cardiovascular event or procedure was 9·32 per 100 patient-years versus 10·50 per 100 patient-years for placebo (0·89 [0·83–0·95], p=0·0012). The difference was mainly attributable to a reduction in the need for coronary angiography and interventions in patients assigned nifedipine, despite an increase in peripheral revascularisation. Nifedipine had no effect on the rate of myocardial infarction.
Addition of nifedipine GITS to conventional treatment of angina pectoris has no effect on major cardiovascular event-free survival. Nifedipine GITS is safe and reduces the need for coronary angiography and interventions.
Published online August 31, 2004
http://image.thelancet.com/extras/04art6402web.pdf</description><subject>Angina pectoris</subject><subject>Angina Pectoris - drug therapy</subject><subject>Calcium</subject><subject>Calcium Channel Blockers - therapeutic use</subject><subject>Cardiovascular Diseases - mortality</subject><subject>Cardiovascular Diseases - prevention & control</subject><subject>Clinical trials</subject><subject>Double-Blind Method</subject><subject>Drugs</subject><subject>Endpoint Determination</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical treatment</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Myocardial infarction</subject><subject>Nifedipine - therapeutic use</subject><subject>Survival 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AA</creatorcontrib><creatorcontrib>Pocock, Stuart J</creatorcontrib><creatorcontrib>Clayton, Tim C</creatorcontrib><creatorcontrib>Motro, Michael</creatorcontrib><creatorcontrib>Parker, John D</creatorcontrib><creatorcontrib>Bourassa, Martial G</creatorcontrib><creatorcontrib>Dart, Anthony M</creatorcontrib><creatorcontrib>Hildebrandt, Per</creatorcontrib><creatorcontrib>Hjalmarson, Åke</creatorcontrib><creatorcontrib>Kragten, Johannes A</creatorcontrib><creatorcontrib>Molhoek, G Peter</creatorcontrib><creatorcontrib>Otterstad, Jan-Erik</creatorcontrib><creatorcontrib>Seabra-Gomes, Ricardo</creatorcontrib><creatorcontrib>Soler-Soler, Jordi</creatorcontrib><creatorcontrib>Weber, Simon</creatorcontrib><creatorcontrib>on behalf of the ACTION (A Coronary disease Trial Investigating Outcome with Nifedipine gastrointestinal therapeutic system) investigators</creatorcontrib><creatorcontrib>Coronary disease Trial Investigating Outcome with Nifedipine gastrointestinal therapeutic system 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Nifedipine gastrointestinal therapeutic system) investigators</aucorp><aucorp>Coronary disease Trial Investigating Outcome with Nifedipine gastrointestinal therapeutic system investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION trial): randomised controlled trial</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>2004-09-04</date><risdate>2004</risdate><volume>364</volume><issue>9437</issue><spage>849</spage><epage>857</epage><pages>849-857</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Calcium antagonists are widely prescribed for angina pectoris but their effect on clinical outcome is controversial. We aimed to investigate the effect of the calcium antagonist nifedipine on long-term outcome in patients with stable angina pectoris.
We randomly assigned 3825 patients with treated stable symptomatic coronary disease to double-blind addition of nifedipine GITS (gastrointestinal therapeutic system) 60 mg once daily and 3840 to placebo. The primary endpoint was the combination of death, acute myocardial infarction, refractory angina, new overt heart failure, debilitating stroke, and peripheral revascularisation. Mean follow-up was 4·9 years (SD 1·1). Analysis was by intention to treat.
310 patients allocated nifedipine died (1.64 per 100 patient-years) compared with 291 people allocated placebo (1·53 per 100 patient-years; hazard ratio 1·07 [95% CI 0·91–1·25], p=0·41). Primary endpoint rates were 4·60 per 100 patient-years for nifedipine and 4·75 per 100 patient-years for placebo (0·97 [0·88–1·07], p=0·54). With nifedipine, rate of death and any cardiovascular event or procedure was 9·32 per 100 patient-years versus 10·50 per 100 patient-years for placebo (0·89 [0·83–0·95], p=0·0012). The difference was mainly attributable to a reduction in the need for coronary angiography and interventions in patients assigned nifedipine, despite an increase in peripheral revascularisation. Nifedipine had no effect on the rate of myocardial infarction.
Addition of nifedipine GITS to conventional treatment of angina pectoris has no effect on major cardiovascular event-free survival. Nifedipine GITS is safe and reduces the need for coronary angiography and interventions.
Published online August 31, 2004
http://image.thelancet.com/extras/04art6402web.pdf</abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>15351192</pmid><doi>10.1016/S0140-6736(04)16980-8</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0140-6736 |
| ispartof | The Lancet (British edition), 2004-09, Vol.364 (9437), p.849-857 |
| issn | 0140-6736 1474-547X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_66848685 |
| source | MEDLINE; ScienceDirect Journals (5 years ago - present); Business Source Complete |
| subjects | Angina pectoris Angina Pectoris - drug therapy Calcium Calcium Channel Blockers - therapeutic use Cardiovascular Diseases - mortality Cardiovascular Diseases - prevention & control Clinical trials Double-Blind Method Drugs Endpoint Determination Female Humans Male Medical treatment Middle Aged Morbidity Mortality Myocardial infarction Nifedipine - therapeutic use Survival Analysis |
| title | Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION trial): randomised controlled trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-15T18%3A21%3A49IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Effect%20of%20long-acting%20nifedipine%20on%20mortality%20and%20cardiovascular%20morbidity%20in%20patients%20with%20stable%20angina%20requiring%20treatment%20(ACTION%20trial):%20randomised%20controlled%20trial&rft.jtitle=The%20Lancet%20(British%20edition)&rft.au=Poole-Wilson,%20Philip%20A&rft.aucorp=on%20behalf%20of%20the%20ACTION%20(A%20Coronary%20disease%20Trial%20Investigating%20Outcome%20with%20Nifedipine%20gastrointestinal%20therapeutic%20system)%20investigators&rft.date=2004-09-04&rft.volume=364&rft.issue=9437&rft.spage=849&rft.epage=857&rft.pages=849-857&rft.issn=0140-6736&rft.eissn=1474-547X&rft.coden=LANCAO&rft_id=info:doi/10.1016/S0140-6736(04)16980-8&rft_dat=%3Cproquest_cross%3E690807651%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=199048561&rft_id=info:pmid/15351192&rft_els_id=S0140673604169808&rfr_iscdi=true |