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

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15 Citations (Scopus)


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
Article numbere003217
JournalJournal of the American Heart Association
Issue number7
Publication statusPublished - 2016 Jul 21


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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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