Impact of Renin-Angiotensin System Inhibitors on Long-Term Clinical Outcomes of Patients With Coronary Artery Spasm

Byoung Geol Choi, Sung Yeon Jeon, Seung-Woon Rha, Sang Ho Park, Min Suk Shim, Se Yeon Choi, Jae Kyeong Byun, Hu Li, Jah Yeon Choi, Eun Jin Park, 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, Hong Seog SeoDong Joo Oh

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

BACKGROUND: Coronary artery spasm (CAS) is a well-known endothelial dysfunction, and a major cause of vasospastic angina (VSA). The renin-angiotensin system (RAS) is known to be closely associated with endothelial function. However, there are only a few studies that investigated the impact of RAS inhibitor on long-term clinical outcomes in VSA patients.

METHODS AND RESULTS: A total of 3349 patients with no significant coronary artery disease, diagnosed with CAS by acetylcholine provocation test were enrolled for this study. Significant CAS was defined as having ≥70% narrowing of the artery after incremental injections of 20, 50, and 100 μg of acetylcholine into the left coronary artery. Patients were divided into 2 groups according to whether the prescription included RAS inhibitor or not (RAS inhibitor group: n=666, non-RAS inhibitor group; n=2683). To adjust for any potential confounders that could cause bias, propensity score matching (PSM) analysis was performed using a logistic regression model. After PSM analysis, 2 matched groups (524 pairs, n=1048 patients, C-statistic=0.845) were generated and their baseline characteristics were balanced. During the 5-year clinical follow-up, the RAS inhibitor group showed a lower incidence of recurrent angina (8.7% versus 14.1%, P=0.027), total death (0.0% versus 1.3%, P=0.045), and total major adverse cardiovascular events (1.0% versus 4.1%, P=0.026) than the non-RAS inhibitor group.

CONCLUSIONS: Chronic RAS inhibitor therapy was associated with lower incidence of cardiovascular events in VSA patients in the 5-year clinical follow-up.

Original languageEnglish
JournalJournal of the American Heart Association
Volume5
Issue number7
DOIs
Publication statusPublished - 2016 Jul 21

Fingerprint

Spasm
Renin-Angiotensin System
Coronary Vessels
Propensity Score
Angiotensins
Acetylcholine
Logistic Models
Incidence
Prescriptions
Coronary Artery Disease
Research Design
Arteries
Injections

Keywords

  • acetylcholine
  • angina
  • angiotensin converting enzyme inhibitor
  • angiotensin receptor blocker
  • coronary artery spasm
  • renin–angiotensin system
  • vasospasm

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of Renin-Angiotensin System Inhibitors on Long-Term Clinical Outcomes of Patients With Coronary Artery Spasm. / Choi, Byoung Geol; Jeon, Sung Yeon; Rha, Seung-Woon; Park, Sang Ho; Shim, Min Suk; Choi, Se Yeon; Byun, Jae Kyeong; Li, Hu; Choi, Jah Yeon; Park, Eun Jin; 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; Seo, Hong Seog; Oh, Dong Joo.

In: Journal of the American Heart Association, Vol. 5, No. 7, 21.07.2016.

Research output: Contribution to journalArticle

Choi, Byoung Geol ; Jeon, Sung Yeon ; Rha, Seung-Woon ; Park, Sang Ho ; Shim, Min Suk ; Choi, Se Yeon ; Byun, Jae Kyeong ; Li, Hu ; Choi, Jah Yeon ; Park, Eun Jin ; 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 ; Seo, Hong Seog ; Oh, Dong Joo. / Impact of Renin-Angiotensin System Inhibitors on Long-Term Clinical Outcomes of Patients With Coronary Artery Spasm. In: Journal of the American Heart Association. 2016 ; Vol. 5, No. 7.
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abstract = "BACKGROUND: Coronary artery spasm (CAS) is a well-known endothelial dysfunction, and a major cause of vasospastic angina (VSA). The renin-angiotensin system (RAS) is known to be closely associated with endothelial function. However, there are only a few studies that investigated the impact of RAS inhibitor on long-term clinical outcomes in VSA patients.METHODS AND RESULTS: A total of 3349 patients with no significant coronary artery disease, diagnosed with CAS by acetylcholine provocation test were enrolled for this study. Significant CAS was defined as having ≥70{\%} narrowing of the artery after incremental injections of 20, 50, and 100 μg of acetylcholine into the left coronary artery. Patients were divided into 2 groups according to whether the prescription included RAS inhibitor or not (RAS inhibitor group: n=666, non-RAS inhibitor group; n=2683). To adjust for any potential confounders that could cause bias, propensity score matching (PSM) analysis was performed using a logistic regression model. After PSM analysis, 2 matched groups (524 pairs, n=1048 patients, C-statistic=0.845) were generated and their baseline characteristics were balanced. During the 5-year clinical follow-up, the RAS inhibitor group showed a lower incidence of recurrent angina (8.7{\%} versus 14.1{\%}, P=0.027), total death (0.0{\%} versus 1.3{\%}, P=0.045), and total major adverse cardiovascular events (1.0{\%} versus 4.1{\%}, P=0.026) than the non-RAS inhibitor group.CONCLUSIONS: Chronic RAS inhibitor therapy was associated with lower incidence of cardiovascular events in VSA patients in the 5-year clinical follow-up.",
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AU - Choi, Byoung Geol

AU - Jeon, Sung Yeon

AU - Rha, Seung-Woon

AU - Park, Sang Ho

AU - Shim, Min Suk

AU - Choi, Se Yeon

AU - Byun, Jae Kyeong

AU - Li, Hu

AU - Choi, Jah Yeon

AU - Park, Eun Jin

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 - Seo, Hong Seog

AU - Oh, Dong Joo

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N2 - BACKGROUND: Coronary artery spasm (CAS) is a well-known endothelial dysfunction, and a major cause of vasospastic angina (VSA). The renin-angiotensin system (RAS) is known to be closely associated with endothelial function. However, there are only a few studies that investigated the impact of RAS inhibitor on long-term clinical outcomes in VSA patients.METHODS AND RESULTS: A total of 3349 patients with no significant coronary artery disease, diagnosed with CAS by acetylcholine provocation test were enrolled for this study. Significant CAS was defined as having ≥70% narrowing of the artery after incremental injections of 20, 50, and 100 μg of acetylcholine into the left coronary artery. Patients were divided into 2 groups according to whether the prescription included RAS inhibitor or not (RAS inhibitor group: n=666, non-RAS inhibitor group; n=2683). To adjust for any potential confounders that could cause bias, propensity score matching (PSM) analysis was performed using a logistic regression model. After PSM analysis, 2 matched groups (524 pairs, n=1048 patients, C-statistic=0.845) were generated and their baseline characteristics were balanced. During the 5-year clinical follow-up, the RAS inhibitor group showed a lower incidence of recurrent angina (8.7% versus 14.1%, P=0.027), total death (0.0% versus 1.3%, P=0.045), and total major adverse cardiovascular events (1.0% versus 4.1%, P=0.026) than the non-RAS inhibitor group.CONCLUSIONS: Chronic RAS inhibitor therapy was associated with lower incidence of cardiovascular events in VSA patients in the 5-year clinical follow-up.

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KW - angiotensin converting enzyme inhibitor

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KW - vasospasm

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