Impact of Diltiazem Alone versus Diltiazem with Nitrate on Five-Year Clinical Outcomes in Patients with Significant Coronary Artery Spasm
1
조회
0
다운로드
1
인용
0
참고문헌
키워드
초록
Purpose: Calcium channel blockers diltiazem and nitrate have been used as selective coronary vasodilators for patients with significantcoronary artery spasm (CAS). However, no study has compared the efficacy of diltiazem alone versus diltiazem with nitrate forlong-term clinical outcomes in patients with CAS. Materials and Methods: A total of 2741 consecutive patients without significant coronary artery disease with positive CAS by acetylcholine(Ach) provocation test between November 2004 and May 2014 were enrolled. Significant CAS was defined as a narrowing of>70% by incremental intracoronary injection of 20, 50, and 100 μg of Ach into the left coronary artery. Patients were assigned to eitherthe diltiazem group (n=842) or the dual group (diltiazem with nitrate, n=1899) at physician discretion. To adjust for potential confounders,a propensity score matching (PSM) analysis was performed using the logistic regression model. After PSM analysis, twowell-balanced groups (811 pairs, n=1622, C-statistic=0.708) were generated. Results: At 5 years, there were similar incidences in primary endpoints, including mortality, myocardial infarction, revascularization,and recurrent angina requiring repeat coronary angiography between the two groups. Diltiazem alone was not an independentpredictor for major adverse cardiovascular events or recurrent angina requiring repeat coronary angiography. Conclusion: Despite the expected improvement of endothelial function and the relief of CAS, the combination of diltiazem and nitratetreatment was not superior to diltiazem alone in reducing mortality and cardiovascular events up to 5 years in patients withsignificant CAS.
Abstract
Purpose: Calcium channel blockers diltiazem and nitrate have been used as selective coronary vasodilators for patients with significantcoronary artery spasm (CAS). However, no study has compared the efficacy of diltiazem alone versus diltiazem with nitrate forlong-term clinical outcomes in patients with CAS. Materials and Methods: A total of 2741 consecutive patients without significant coronary artery disease with positive CAS by acetylcholine(Ach) provocation test between November 2004 and May 2014 were enrolled. Significant CAS was defined as a narrowing of>70% by incremental intracoronary injection of 20, 50, and 100 μg of Ach into the left coronary artery. Patients were assigned to eitherthe diltiazem group (n=842) or the dual group (diltiazem with nitrate, n=1899) at physician discretion. To adjust for potential confounders,a propensity score matching (PSM) analysis was performed using the logistic regression model. After PSM analysis, twowell-balanced groups (811 pairs, n=1622, C-statistic=0.708) were generated. Results: At 5 years, there were similar incidences in primary endpoints, including mortality, myocardial infarction, revascularization,and recurrent angina requiring repeat coronary angiography between the two groups. Diltiazem alone was not an independentpredictor for major adverse cardiovascular events or recurrent angina requiring repeat coronary angiography. Conclusion: Despite the expected improvement of endothelial function and the relief of CAS, the combination of diltiazem and nitratetreatment was not superior to diltiazem alone in reducing mortality and cardiovascular events up to 5 years in patients withsignificant CAS.
참고문헌 (22)
- Yamashina Y, "Differentiating between comatose patients resuscitated from acute coronary syndrome-associated and subarachnoid hemorrhage-associated out-of-hospital cardiac arrest", J Cardiol, 65, pp.508~513 (2015)
- Ajani AE, "The mystery of coronary artery spasm", Heart Lung Circ, 16, pp.10~15 (2007)
- Tanabe K, "Increased levels of the oxidative stress marker, nitrotyrosine in patients with provocation test-induced coronary vasospasm", J Cardiol, 64, pp.86~90 (2014)
- 박지영, "The Impact of High Sensitivity C-Reactive Protein Level on Coronary Artery Spasm as Assessed by Intracoronary Acetylcholine Provocation Test", Yonsei Medical Journal, 54(6), pp.1299~1304 (2013), 연세대학교의과대학[DOI]
- Park JY, "Multivessel versus single vessel spasm, as assessed by the intracoronary acetylcholine provocation test, in Korean patients", Clin Exp Pharmacol Physiol, 38, pp.819~823 (2011)
- Murad F, "Shattuck Lecture. Nitric oxide and cyclic GMP in cell signaling and drug development", N Engl J Med, 355, pp.2003~2011 (2006)
- Moncada S, "Nitric oxide: physiology, pathophysiology, and pharmacology", Pharmacol Rev, 43, pp.109~142 (1991)
- Kugiyama K, "Supersensitive dilator response to nitroglycerin but not to atrial natriuretic peptide in spastic coronary arteries in coronary spastic angina", Am J Cardiol, 79, pp.606~610 (1997)
- Boulanger C, "Release of endothelin from the porcine aorta. Inhibition by endothelium-derived nitric oxide", J Clin Invest, 85, pp.587~590 (1990)
- Takemoto M, "Important role of tissue angiotensin-converting enzyme activity in the pathogenesis of coronary vascular and myocardial structural changes induced by long-term blockade of nitric oxide synthesis in rats", J Clin Invest, 99, pp.278~287 (1997)
- Kaneda H, "Coronary artery spasm and the polymorphisms of the endothelial nitric oxide synthase gene", Circ J, 70, pp.409~413 (2006)
- Vanhoutte PM, "Endothelium-derived relaxing factor and coronary vasospasm", Circulation, 80, pp.1~9 (1989)
- Lanza GA, "Mechanisms of coronary artery spasm", Circulation, 124, pp.1774~1782 (2011)
- Takahashi J, "Prognostic impact of chronic nitrate therapy in patients with vasospastic angina: multicentre registry study of the Japanese coronary spasm association", Eur Heart J, 36, pp.228~237 (2015)
- Pristipino C, "Major racial differences in coronary constrictor response between japanese and caucasians with recent myocardial infarction", Circulation, 101, pp.1102~1108 (2000)
- Kimura E, "Treatment of variant angina with drugs: a survey of 11 cardiology institutes in Japan", Circulation, 63, pp.844~848 (1981)
- Choi BG, "Five-year clinical outcomes in patients with significant coronary artery spasm: a propensity score-matched analysis", Int J Cardiol, 184, pp.533~539 (2015)
- Ong P, "Patterns of coronary vasomotor responses to intracoronary acetylcholine provocation", Heart, 99, pp.1288~1295 (2013)
- Ong P, "Clinical usefulness, angiographic characteristics, and safety evaluation of intracoronary acetylcholine provocation testing among 921 consecutive white patients with unobstructed coronary arteries", Circulation, 129, pp.1723~1730 (2014)
- Ong P, "3-year follow-up of patients with coronary artery spasm as cause of acute coronary syndrome: the CASPAR (coronary artery spasm in patients with acute coronary syndrome) study follow-up", J Am Coll Cardiol, 57, pp.147~152 (2011)
- JCS Joint Working Group, "Guidelines for diagnosis and treatment of patients with vasospastic angina (Coronary Spastic Angina) (JCS 2013)", Circ J, 78, pp.2779~2801 (2014)
- Li YJ, "Diabetes mellitus is not a risk factor for coronary artery spasm as assessed by an intracoronary acetylcholine provocation test: angiographic and clinical characteristics of 986 patients", J Invasive Cardiol, 26, pp.234~239 (2014)