Impact of diltiazem alone versus diltiazem with nitrate on five-year clinical outcomes in patients with significant coronary artery spasm

Taeshik Park, Ji Young Park, Seung-Woon Rha, Hong Seog Seo, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun, Sang Ho Park, Eun Jin Park, Jah Yeon Choi, Sung Hun Park, Jae Joong Lee, Sunki Lee, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Dong Joo Oh

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Abstract

Purpose: Calcium channel blockers diltiazem and nitrate have been used as selective coronary vasodilators for patients with significant coronary artery spasm (CAS). However, no study has compared the efficacy of diltiazem alone versus diltiazem with nitrate for long-term clinical outcomes in patients with CAS. Materials and Methods: A total of 2741 consecutive patients without significant coronary artery disease with positive CAS by acetylcholine (Ach) provocation test between November 2004 and May 2014 were enrolled. Significant CAS was defined as a narrowing of >70% by incremental intracoronary injection of 20, 50, and 100 μg of Ach into the left coronary artery. Patients were assigned to either the diltiazem group (n=842) or the dual group (diltiazem with nitrate, n=1899) at physician discretion. To adjust for potential confounders, a propensity score matching (PSM) analysis was performed using the logistic regression model. After PSM analysis, two well-balanced groups (811 pairs, n=1622, C-statistic=0.708) were generated. Results: At 5 years, there were similar incidences in primary endpoints, including mortality, myocardial infarction, revascularization, and recurrent angina requiring repeat coronary angiography between the two groups. Diltiazem alone was not an independent predictor for major adverse cardiovascular events or recurrent angina requiring repeat coronary angiography. Conclusion: Despite the expected improvement of endothelial function and the relief of CAS, the combination of diltiazem and nitrate treatment was not superior to diltiazem alone in reducing mortality and cardiovascular events up to 5 years in patients with significant CAS.

Original languageEnglish
Pages (from-to)90-98
Number of pages9
JournalYonsei Medical Journal
Volume58
Issue number1
DOIs
Publication statusPublished - 2017 Jan 1

Fingerprint

Diltiazem
Spasm
Nitrates
Coronary Vessels
Propensity Score
Coronary Angiography
Acetylcholine
Logistic Models
Myocardial Revascularization
Mortality
Calcium Channel Blockers
Vasodilator Agents
Coronary Artery Disease
Myocardial Infarction
Physicians
Injections
Incidence

Keywords

  • Coronary vasospasm
  • Diltiazem
  • Nitrate

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Impact of diltiazem alone versus diltiazem with nitrate on five-year clinical outcomes in patients with significant coronary artery spasm. / Park, Taeshik; Park, Ji Young; Rha, Seung-Woon; Seo, Hong Seog; Choi, Byoung Geol; Choi, Se Yeon; Byun, Jae Kyeong; Park, Sang Ho; Park, Eun Jin; Choi, Jah Yeon; Park, Sung Hun; Lee, Jae Joong; Lee, Sunki; Na, Jin Oh; Choi, Cheol Ung; Lim, Hong Euy; Kim, Jin Won; Kim, Eung Ju; Park, Chang Gyu; Oh, Dong Joo.

In: Yonsei Medical Journal, Vol. 58, No. 1, 01.01.2017, p. 90-98.

Research output: Contribution to journalArticle

Park, Taeshik ; Park, Ji Young ; Rha, Seung-Woon ; Seo, Hong Seog ; Choi, Byoung Geol ; Choi, Se Yeon ; Byun, Jae Kyeong ; Park, Sang Ho ; Park, Eun Jin ; Choi, Jah Yeon ; Park, Sung Hun ; Lee, Jae Joong ; Lee, Sunki ; Na, Jin Oh ; Choi, Cheol Ung ; Lim, Hong Euy ; Kim, Jin Won ; Kim, Eung Ju ; Park, Chang Gyu ; Oh, Dong Joo. / Impact of diltiazem alone versus diltiazem with nitrate on five-year clinical outcomes in patients with significant coronary artery spasm. In: Yonsei Medical Journal. 2017 ; Vol. 58, No. 1. pp. 90-98.
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AU - Park, Ji Young

AU - Rha, Seung-Woon

AU - Seo, Hong Seog

AU - Choi, Byoung Geol

AU - Choi, Se Yeon

AU - Byun, Jae Kyeong

AU - Park, Sang Ho

AU - Park, Eun Jin

AU - Choi, Jah Yeon

AU - Park, Sung Hun

AU - Lee, Jae Joong

AU - Lee, Sunki

AU - Na, Jin Oh

AU - Choi, Cheol Ung

AU - Lim, Hong Euy

AU - Kim, Jin Won

AU - Kim, Eung Ju

AU - Park, Chang Gyu

AU - Oh, Dong Joo

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N2 - Purpose: Calcium channel blockers diltiazem and nitrate have been used as selective coronary vasodilators for patients with significant coronary artery spasm (CAS). However, no study has compared the efficacy of diltiazem alone versus diltiazem with nitrate for long-term clinical outcomes in patients with CAS. Materials and Methods: A total of 2741 consecutive patients without significant coronary artery disease with positive CAS by acetylcholine (Ach) provocation test between November 2004 and May 2014 were enrolled. Significant CAS was defined as a narrowing of >70% by incremental intracoronary injection of 20, 50, and 100 μg of Ach into the left coronary artery. Patients were assigned to either the diltiazem group (n=842) or the dual group (diltiazem with nitrate, n=1899) at physician discretion. To adjust for potential confounders, a propensity score matching (PSM) analysis was performed using the logistic regression model. After PSM analysis, two well-balanced groups (811 pairs, n=1622, C-statistic=0.708) were generated. Results: At 5 years, there were similar incidences in primary endpoints, including mortality, myocardial infarction, revascularization, and recurrent angina requiring repeat coronary angiography between the two groups. Diltiazem alone was not an independent predictor for major adverse cardiovascular events or recurrent angina requiring repeat coronary angiography. Conclusion: Despite the expected improvement of endothelial function and the relief of CAS, the combination of diltiazem and nitrate treatment was not superior to diltiazem alone in reducing mortality and cardiovascular events up to 5 years in patients with significant CAS.

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