Impact of Statin Therapy on Clinical Outcome in Patients With Coronary Spasm

Abstract

BackgroundStatin therapy reduces the risk of cardiovascular events in patients with obstructive coronary artery disease. The aim of the present study was to determine the effects of statins on the prognosis of patients with coronary vasospastic angina (VSA) free of significant atherosclerotic stenosis.Methods and ResultsAfter exclusion of 475 from 1877 consecutive patients who underwent an acetylcholine‐provocation test between January 1991 and December 2010, data of 640 VSA patients without significant organic stenosis of the remaining 1402 were analyzed retrospectively. Propensity score matching was performed to reduce the effect of treatment‐selection bias and possible confounders. The primary endpoint was major adverse cardiac events (MACE), including cardiac death, nonfatal myocardial infarction, and unstable angina. Among the study population, dyslipidemia on admission was identified in 160 of 168 (95.2%) patients of the statin group compared with only 125 of 472 (26.5%) of the no‐statin group. Of the 640 patients, 24 (3.8%) developed MACE. Multivariate Cox hazard regression analysis identified statin therapy as a significant negative predictor of MACE (hazard ratio, 0.11; 95% CI, 0.02–0.84; P=0.033). In the propensity‐score matched cohorts (n=128 each), Kaplan–Meier survival curve showed a better 5‐year MACE‐free survival rate for patients of the statin group compared to the no‐statin group (100% vs 91.7%, respectively; P=0.002).ConclusionsStatin therapy correlated with a lower rate of cardiovascular events in VSA patients free of significant organic stenosis. Statins seems to improve the prognosis of VSA patients free of significant organic stenosis.

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.…”

Vasospastic angina: pathophysiology and clinical significance

“…значительно ограничивало СКА, индуцированного АХ, у пациентов с ВС без обструктивного поражения КА [22]. В более позднем ретроспективном исследовании подтверждалось, что прием статинов подавляет СКА и улучшает прогноз ВС [44]. В настоящее время известно недостаточно данных, характеризующих эффективность антагонистов альфа-1-адренергических рецепторов для лечения ВС.…”

A Rare Case of Vasospastic Angina Presenting with Inferior Lead ST-segment Elevation and Ventricular Fibrillation in the Absence of Coronary Obstruction: A Case Report

“…Extensive trials have demonstrated that nitrates are an effective treatment for reducing the frequency of angina in patients with VSA. Studies looked at statin drugs in conjunction with CCBs in preventing coronary artery vasospasm and found that the addition of fluvastatin to CCBs for six months significantly reduced acetylcholine-provoked spasm in patients with VSA without obstructive coronary artery disease [16][17]. There was a correlation between starting statin drug therapy and reduced long-term cardiovascular events in patients with VSA without obstructive coronary artery disease.…”