Prevention Of Cardiac Events In Patients With Angina-Pectoris - Results Of The Apsis Study

The APSIS (Angina Prognosis Study in Stockholm) study is a single centre study aimed at disclosing the natural history of angina pectoris and finding factors of importance for prognosis. The study has been set up to evaluate whether there are any differences in treatment effects of metoprolol and verapamil in the occurrences of myocardial infarction, cardiac death, or incapacitating angina pectoris during long-term follow-up. The study comprises 809 patients of whom 31 % are women. Mean age is 59 years. At the time of inclusion, patients had to be under 70 years of age and should not have suffered a myocardial infarction within the last 3 years. The only other exclusion criteria were contra-indications for either drug or other concomitant severe disease. The patients were followed for a median time of 3·4 years. Longest follow-up was 75 months. During this period 6·2% of the verampil-treated patients and 5·4% of the metoprolol-treated patients died. The mode of death was cardiovascular in 81% of the cases. 26·4% in the metoprolol group and 24·1% in the verampil group had an atherosclerotic event other than death, i.e. myocardial infarction, cerebrovascular incident or incapacitating angina pectoris. Psycho-social variables were also analysed and constituted primary endpoints. There was no difference in overall wellbeing. Psychosomatic symptoms and sleep disturbances improved slightly but significantly in both groups. Thus, there were no differences in major clinical outcome either on cardiovascular endpoints or quality of life between the two treatments. However, platelet aggregability in vivo, as studied by filtragometry in a subgroup, was attenuated by verapamil but not by metoprolol. Thus, the magnitude of therapeutic effect is the same between the two drugs and, as has been shown previously, the symptomatic relief is also similar. The mechanisms behind these therapeutic effects may, however, be different and need further evaluation. A full report of the APSIS study is under peer review.