Impact of Renin‐Angiotensin System Inhibitors on Long‐Term Clinical Outcomes of Patients With Coronary Artery Spasm

Abstract

BackgroundCoronary artery spasm (CAS) is a well‐known endothelial dysfunction, and a major cause of vasospastic angina (VSA). The renin–angiotensin system (RAS) is known to be closely associated with endothelial function. However, there are only a few studies that investigated the impact of RAS inhibitor on long‐term clinical outcomes in VSA patients.Methods and ResultsA total of 3349 patients with no significant coronary artery disease, diagnosed with CAS by acetylcholine provocation test were enrolled for this study. Significant CAS was defined as having ≥70% narrowing of the artery after incremental injections of 20, 50, and 100 μg of acetylcholine into the left coronary artery. Patients were divided into 2 groups according to whether the prescription included RAS inhibitor or not (RAS inhibitor group: n=666, non‐RAS inhibitor group; n=2683). To adjust for any potential confounders that could cause bias, propensity score matching (PSM) analysis was performed using a logistic regression model. After PSM analysis, 2 matched groups (524 pairs, n=1048 patients, C‐statistic=0.845) were generated and their baseline characteristics were balanced. During the 5‐year clinical follow‐up, the RAS inhibitor group showed a lower incidence of recurrent angina (8.7% versus 14.1%, P=0.027), total death (0.0% versus 1.3%, P=0.045), and total major adverse cardiovascular events (1.0% versus 4.1%, P=0.026) than the non‐RAS inhibitor group.ConclusionsChronic RAS inhibitor therapy was associated with lower incidence of cardiovascular events in VSA patients in the 5‐year clinical follow‐up.

Prognosis of stent implantation on variant angina with severe organic stenosis

“…One case had 70% restenosis in stents, two cases had 30% restenosis in stents and the other stents had good adherence and no obvious restenosis. The effective rate of CCB in VA patients in Japan was 92.5% [16] which is similar to our stenting group (88%)and stent-free group(89%) Other literatures reported that aspirin, statins and ACEi could prevent spasm and improve the prognosis of patients [17][18][19] . In addition, we included VA patients,whose diagnostic criteria included resting angina and transient elevation of ST segment one ECG without spasm provocation test, but could be diagnosed as VA with high specificity [10,20,21] , it has been reported that provocation test is safe and effective for VA patients with no significant stenosis [22] ,but provocation test has more advantages than disadvantages for VA patients with severe stenosis [23] , We believe that provocation test may lead to unstable plaque shedding, which increases the incidence of MACE and affects the results of the trial.…”

The multi-vessel and diffuse coronary spasm is a risk factor for persistent angina in patients received anti-angina medication

“…The design of this registry has been introduced before. [2,11–14] In brief, it is a single-center, observational, prospective, all-comers registry designed to reflect the “real world” practice since 2004. Data were collected by a trained study-coordinator with a standardized case report form.…”

“…The design of the ACH provocation test has been introduced before. [2,11–14] Initial investigation for CAG included clinical history taking and non-invasive stress tests such as treadmill test, stress echocardiography, and radionuclide study. CAG was performed to confirm the presence of significant CAD.…”

Impact of Insulin Resistance on Acetylcholine-Induced Coronary Artery Spasm in Non-Diabetic Patients

“…The design of this registry has been described previously in detail. 9 10 11 12 13 14 Data were collected by a trained study-coordinator with a standardized case report form. Standardized definitions of all patient-related variables and clinical diagnoses were used.…”

“…The design of the Ach provocation test has been described before. 9 10 11 12 13 Initial investigation for CAG included clinical history taking and non-invasive stress tests, such as treadmill test, stress echocardiography, and radionuclide study. Then, CAG was performed to confirm the presence of significant CAD.…”