The Clinical Impact of Nicorandil Treatment in Addition to Standard Antianginal Medications in Patients With Significant Coronary Artery Spasm up to 5 Years

초록

Background Coronary artery spasm (CAS) has been known as one of the major causes of myocardial ischemia. Nicorandil has been used as selective vasodilator for significant CAS patients. However, there are limited data on the long-term impact of nicorandil on clinical outcomes in Korean patients with significant CAS. Methods A total of 3,886 patients with significant CAS by acetylcholine provocation test were enrolled. The patients were divided into 2 groups: nicorandil group, including nicorandil, diltiazem, trimetazidine, and nitrate (n = 578), and control group, including except nicorandil (n = 777). To adjust for confounding factors, propensity score matching was performed, and 449 pairs were generated. The primary endpoint was major adverse cardiac and cerebral events (MACCE)1, including major adverse cardiac event (MACE) and stroke. The secondary endpoint was MACCE2, including recurrent angina requiring follow-up coronary angiogram. Results At baseline, most characteristics were similar between the 2 groups, except diastolic blood pressure which was higher in the nicorandil group. However, after propensity score matching (PSM), the difference was not observed. After 5 years, the incidence of recurrent angina was significantly higher in the control group (HR: 1.40; 95% CI; 1.02-1.91; P = 0.036). However, after PSM, despite the nicorandil group showing numerically lower incidence of recurrent angina, it did not reach statistical significance. Conclusions In significant CAS patients, additional nicorandil treatment on the top of standard antianginal medication was not associated with reduced incidence of recurrent angina and adverse major clinical outcomes up to 5 years.