Abstract 14717: A Meta-Analysis of Prognostic Effects of Calcium Channel Blockers in Patients with Vasospastic Angina
Background: Although calcium channel blockers (CCBs) are highly effective for suppression of vasospastic angina (VSA) attacks, their prognostic effects in VSA patients remain to be examined in a large number of patients.
Methods and Results: We searched article databases for related papers, and performed a meta-analysis regarding the effects of CCBs on major adverse cardiovascular events (MACE) in Japanese VSA patients with the 4 previous studies. A total of 1,997 patients with positive coronary spasm provocation tests were evaluated. They were treated with either alone or combination of benidipine (n=320), amlodipine (n=308), nifedipine (n=182) or diltiazem (n=960). The frequencies of anginal attacks at follow up in the benidipine (0.7±1.1 attacks/month) and nifedipine (0.7±1.6) groups were significantly lower than those in the amlodipine (1.4±1.6) and diltiazem (1.6±5.9) groups (P<0.001). MACE were observed in 143 patients, with a median follow-up period of 4.4 years. MACE occurred significantly less in the patients treated with benidipine compared with those without it (P=0.031). The HR for the occurrence of MACE was significantly lower in the patients treated with benidipine compared to those without benidipine (HR=0.46, CI=0.22-0.95, P=0.035). The the hazard ratio (HR) was also significantly lower in the patients treated with benidipine, even after correction for the background factors (HR=0.41, CI=0.20-0.85, P=0.016). Multivariate analysis showed that diabetes mellitus and coronary artery disease were independent risk factors for MACE. When the occurrence of MACE was compared among the 1,349 VSA patients treated with a single CCB, MACE occurred significantly less in the benidipine group as compared with the diltiazem group (P=0.034). After correction by the propensity score, there was no significant difference in any factors among the 4 CCB groups, and again the incidence of MACE in the benidipine group was significantly lower as compared with the diltiazem (P<0.001) and the amlodipine groups (P=0.042).
Conclusions: These results suggest that among the 4 major CCBs that effectively suppress VSA attacks in general, benidipine showed significantly more beneficial prognostic effects than others.
- © 2010 by American Heart Association, Inc.