Abstract 2861: Recurrence of Coronary Spasm after Withdrawal of Ca-antagonists -Suppression by an HMG Co-A Reductase Inhibitor
(Background) We and others have established that Ca-antagonists are the first line medications for the treatment of coronary spasm; however, Ca-antagonists do not necessarily totally suppress coronary spasm. It is not known however how long Ca-antagonists should be administered in patients with coronary spasm. Statins have been shown to improve morbidity and mortality in patients with coronary artery disease; however, it is not known whether statins also suppress coronary spasm.
(Purpose) This study was designed to examine whether coronary spasm recurs after withdrawal of Ca-antagonists and whether satins have any suppressive or inhibitory effects on coronary spasm recurrence.
(Methods) Fifty-two patients (average age, 61.8 ± 1.7; 33 males, 19 females) in whom coronary spasm was induced by intra-coronary infusion of Acetylcholine were randomly assigned to either the placebo group (25 patients) or the statin group (27 patients; Fluvastatin, 20–40 mg/day). In all patients, Ca-antagonists were administered for 6 months and then the provocation test was repeated 7 days after the withdrawal of Ca-antagonists. Coronary spasm was defined as an abnormal contraction of coronary arteries associated with the appearance of ischemic ECG changes.
(Results) Serum levels of total cholesterol and LDL-cholesterol were significantly decreased at 6 months in the statin group (185.2 ± 6.6 mg/dl vs.160.2 ± 6.7 mg/dl, p<0.01, and 107.4 ± 7.0 mg/dl vs. 80.0 ± 5.4 mg/dl, p<0.01, respectively), whereas these levels remained unchanged in the placebo group. Recurrence rate for coronary spasm in the placebo group was 83.8 % (positive in 31 of 37 vessels, p<0.05 vs. at registration), whereas it was 54.1 % in the statin group (positive in 20 of 37 vessels, p<0.001 vs. at registration). The recurrence rate in the statin group was significantly lower than that of the placebo group (54.1 % vs. 83.8%, P<0.01).
(Conclusions) The recurrence rate of coronary spasm is very high after withdrawal of 6 month administration of Ca-antagonists. These results indicate that Ca-antagonists should be continued for more than 6 months to suppress coronary spasm. Fluvastatin significantly suppresses the recurrence of coronary spasm and is a novel therapeutic agent for coronary spasm.