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Medical treatment of myocardial ischemia in coronary artery disease: effect of drug regime and irregular dosing in the CAPE II trial

John E. Deanfield, FRCP^*,*, Jean-Marie Detry, MD, Philippe Sellier, MD, Paul R. Lichtlen, MD, Eric Thaulow, MD^||, Jan Bultas, MD^¶, Claudia Brennan, MS^#, Sarah T. Young, PhD^#, Bruce Beckerman, MD^# CAPE II Trial Investigators

^* Great Ormond Street Hospital for Children, London, United Kingdom
Saint-Luc University Hospital, Brussels, Belgium
Broussais Hospital, Paris, France
Hannover Medical School, Hannover, Germany
^|| Children’s and Women’s Clinic, Rikshospitalet Oslo, Norway
^¶ Charles University, Prague, Czech Republic
^# Pfizer Inc., New York, New York, USA

View larger version (21K): [in a new window]   Figure 1 Study design.

View larger version (29K): [in a new window]   Figure 2 Ambulatory ECG monitoring during phase 2 (monotherapy). Both amlodipine and diltiazem (Adizem XL) reduced ischemic events, but there was a significantly better effect in the amlodipine-treated patients after omission of a single drug dose (see text). *p < 0.002 between amlodipine and diltiazem (Adizem XL) withdrawal.

View larger version (30K): [in a new window]   Figure 3 Circadian pattern of transient ischemia during active therapy and after drug withdrawal. Drug monotherapy phase (A) and combination phase (B).

View larger version (37K): [in a new window]   Figure 4 Angina attacks (A) and nitroglycerin consumption (B) during monotherapy and combination therapy. Both amlodipine and diltiazem (Adizem XL) reduced angina and nitroglycerin consumption (p < 0.0001). Nitroglycerin consumption was significantly lower in patients receiving amlodipine/atenolol. *p = 0.02.