Nonresponsiveness to antianginal therapy--a frequent problem?

Nonresponsiveness to anginal treatment varies greatly and may be due to either the pathophysiology of the patients or the special pharmacology of different antianginal drugs. Therefore, individualized therapy, taking all aspects of patient and drug into account to improve responsiveness, seems desirable. Patients may vary--thus influencing the outcome of antianginal therapy--with respect to the severity of the disease, vasospastic components, and the pattern of organic vessel involvement. Drugs differ with respect to the ease of dose-finding, tolerance, the extent of spasmolytic activity, side effects, and paradoxical effects. In no patient with coronary artery disease is the outcome to treatment predictable, even if a full diagnostic evaluation of the patient has been performed. For example, the individual relevance of angiographically documented vasospastic components in patients with underlying organic multivessel disease can hardly be predicted, and therefore the appropriate choice of an antianginal drug is difficult. In addition, a full invasive evaluation of all coronary patients, only to find arguments for the optimal drug therapy, is not feasible. Therefore, the empiric approach is recommended for daily routine. Drugs are preferred that usually provide a high response rate and the smallest cause for concern.