Are anti-platelet drugs of value in the management of patients with chronic stable angina? A study with ticlopidine.

Thirty patients (28 males and 2 females) aged 46-68 years with established chronic stable angina were studied in a placebo-controlled double-blind crossover trial to examine the efficacy of oral ticlopidine (an antiplatelet agent) 250 mg twice daily. The baseline mean +/- SEM exercise time of 7.5 +/- 0.5 min rose to 8.1 +/- 0.6 min after 2 weeks of placebo run-in, 8.8 +/- 0.7 min after 4 weeks of double-blind placebo, and to 9.2 +/- 0.6 min with ticlopidine therapy; none of these changes achieved statistical significance. Similarly, time to the development of 1 mm ST-segment depression, maximal ST-segment depression, heart rate, and rate-pressure product failed to show any statistically significant changes during ticlopidine therapy. Ambulatory electrocardiographic monitoring showed that the mean number of episodes of ST-segment depression greater than 1 mm remained unaltered during ticlopidine therapy. Four patients (3 during placebo, 1 during ticlopidine) stopped treatment prematurely because of unstable angina and two because of adverse effects. Our data suggest that ticlopidine has no significant effect on objective indices of myocardial ischemia in patients with chronic stable angina, that placebo has no effect on the objective indices of myocardial ischemia derived from exercise testing and ambulatory electrocardiographic monitoring, and that exercise testing and ambulatory electrocardiographic monitoring in patients with chronic stable angina pectoris are reproducible.