Abstract 3206: The Effects of Statins on Coronary Artery Spasm Utilizing Quantitative Coronary Analysis
Background: There is increasing evidence that a statin suppresses cardiovascular events in patients with coronary artery disease. However, it is not known whether a statin also suppresses coronary spasm.
Purpose: The purpose of this study was to examine whether a statin suppresses coronary spasm.
Methods: This study was a randomized controlled open-label study or Statins for Coronary Artery Spasm Trial. Seventy-eight patients in whom coronary spasm was induced by intracoronary injection of acetylcholine (Ach) for the left and right coronary arteries were randomly assigned to either the statin (fluvastain and standard Ca-antagonist therapy) group or the non-statin (standard Ca-antagonist therapy) group for 6 months of treatment. In 64 of them (average age, 62.5 ±2.5 yrs., 31 males and 33 females, 31 patients for the statin group and 33 patients for the non-statin group), the provocation test were repeated on withholding of all of vasodilatory drugs after 6 months of treatment. Quantitative coronary angiographic analyses (QCA) were done on 88 vessels (53 left coronary arteries and 35 right coronary arteries) on both the spasm segments and the non-spasm segments at baseline and after 6 months of treatment. Coronary spasm was defined as an excessive vasoconstriction of an epicardial coronary artery associated with ischemic ECG changes.
Results: In both groups, the induction rate of coronary spasm was significantly reduced after 6 months of treatment (79.1%, p=0.002 in the non-statin group and 48.9%, p<0.0001 in the statin group, respectively). Thus, the induction rate of coronary spasm was significantly lower in the statin group than in the non-statin group (48.9% vs. 79.1%, p=0.006) after 6 months of treatment. QCA revealed that the vasoconstrictor response of the spasm segments in the left coronary artery to injection of Ach 50γ ( % change in diameter) was significantly reduced in the statin group as compared with the non-statin group (−21.3±16.9% vs. −30.1±20.3%, p=0.009) at 6 months.
Conclusions: The addition of a statin (fluvastatin) to the standard Ca-antagonist treatment significantly reduced the induction rate of coronary spasm after 6 months. A statin (fluvastain) added to Ca-antagonists may thus be useful as a novel treatment for coronary spasm.