Efficacy and safety of the endothelin-1 receptor antagonist macitentan in epicardial and microvascular vasospasm; a proof-of-concept study

Coronary Spasm Testing with Acetylcholine: A Powerful Tool for a Personalized Therapy of Coronary Vasomotor Disorders

“…Genetic polymorphisms of ET-1 facilitate the development of CAS [ 30 ] and a landmark study by Toyo-oka et al showed high levels of endothelin-1 in the coronary microenvironment of patients with CAS [ 161 ]. However, the recent placebo-controlled randomized VERA trial failed to demonstrate benefits from Macitentan, a potent inhibitor of the ET-1 receptor, on anginal burden among 28 patients with Ach-induced CAS and >3 anginal attacks per week [ 162 ].…”

Recent highlights on coronary artery disease from the International Journal of Cardiology Heart & Vasculature

“…Since ACh provocation test does not identify all patients who could benefit from appropriate therapy [22] , flow-recovery time has been suggested as a parameter to identify patients with equivocal results of ACh test who may receive appropriate medical treatment to improve symptoms and quality of life [23] . The same group recently conducted a randomized, double-blind, placebo-controlled trial, which failed to demonstrate the usefulness of the endothelin-1 receptor antagonist macitentan in identifying patients with epicardial or microvascular coronary vasospasm who remain symptomatic despite background pharmacological treatment [24] . Spinal cord stimulation is a new option to treat patients with refractory angina pectoris, which has been shown to improve quality of life, reduce frequency of angina, and decrease the use of short-acting nitrates, which are frequently applied in this scenario [2] .…”