Impact of Renin-Angiotensin System Inhibitors on Long-Term Clinical Outcomes of Patients With Coronary Artery Spasm
- Authors
- Choi, Byoung Geol; Jeon, Sung Yeon; Rha, Seung-Woon; Park, Sang-Ho; Shim, Min Suk; Choi, Se Yeon; Byun, Jae Kyeong; Li, Hu; Choi, Jah Yeon; Park, Eun Jin; Park, Sung-Hun; Lee, Jae Joong; Lee, Sunki; Na, Jin Oh; Choi, Cheol Ung; Lim, Hong Euy; Kim, Jin Won; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo
- Issue Date
- Jul-2016
- Publisher
- Wiley-Blackwell
- Keywords
- acetylcholine; angina; angiotensin converting enzyme inhibitor; angiotensin receptor blocker; coronary artery spasm; renin-angiotensin system; vasospasm
- Citation
- Journal of the American Heart Association, v.5, no.7
- Indexed
- SCIE
SCOPUS
- Journal Title
- Journal of the American Heart Association
- Volume
- 5
- Number
- 7
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/6280
- DOI
- 10.1161/JAHA.116.003217
- ISSN
- 2047-9980
2047-9980
- Abstract
- Background
Coronary 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 Results
A 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.
Conclusions
Chronic RAS inhibitor therapy was associated with lower incidence of cardiovascular events in VSA patients in the 5‐year clinical follow‐up.
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Collections - 4. Research institute > Cardiovascular Research Institute > 1. Journal Articles
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