Abstract 12627: Prognostic Impact of Long-acting Nitrate Therapy in Patients with Vasospastic Angina -A Report from the Japanese Coronary Spasm Association-
Background: Although long-acting nitrates have been widely used for the treatment of ischemic heart diseases including vasospastic angina (VSA), its prognostic benefit remains controversial. We thus aimed to elucidate the prognostic impact of long-acting nitrate therapy in VSA patients in our nationwide multicenter registry study by the Japanese Coronary Spasm Association.
Methods: Between September 2007 and December 2008, we enrolled a total of 1,429 VSA patients (male/female, 1090/339; median 66 years) from the 47 participating institutes in Japan with a mean follow-up period of 32 months. The primary endpoint was defined as major adverse cardiac events (MACE). A propensity score (PS) for being treated with long-acting nitrates was calculated using clinical characteristics and other treatments, and the differences between patients with and those without long-acting nitrates were adjusted using PS matching.
Results: Among the 1,429 VSA patients, 695 (49%) were treated with long-acting nitrates. As compared with patients without long-acting nitrates, those with the drugs were characterized by older age (65 vs. 67 years, P<0.05), higher incidence of ST elevation during spontaneous angina attack (16 vs. 23%, P<0.01) and multivessel spasm during spasm provocation test (24 vs. 30%, P<0.001). PS matching identified 501 patients with nitrates who matched to an equal number of patients without the drugs. These 2 groups were well balanced with regard to all baseline variables. Calcium channel blockers (CCBs), as first-line therapy for VSA, were used in more than 90% of both groups. Importantly, Kaplan-Meier curve demonstrated that MACE-free survival rate was comparable between the patients with and those without long-acting nitrates (Figure).
Conclusions: These results indicate that long-acting nitrate therapy does not affect the long-term prognosis of VSA patients when combined with CCBs.
- © 2012 by American Heart Association, Inc.