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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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
Issue number1
Publication statusPublished - 2017 Jan 1



  • Coronary vasospasm
  • Diltiazem
  • Nitrate

ASJC Scopus subject areas

  • Medicine(all)

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