Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin Chikushino-shi, 818-8502 Fukuoka, Japan.
J Cardiol. 2009 Aug;54(1):10-20. doi: 10.1016/j.jjcc.2009.02.013. Epub 2009 Apr 1.
A retrospective study was conducted to elucidate contributing factors on the outcome of patients with vasospastic angina.
Two hundred ninety-two patients with angina in whom coronary vasospasm was documented were followed up (mean 4.3+/-3.6 years) to determine the relationship between the occurrence of cardiovascular events with available clinical factors including therapeutic drugs. Cardiovascular events were defined as fatal and non-fatal cardiovascular disorder events.
Several clinical variables including age, elevated creatinine level, low high-density lipoprotein (HDL) cholesterol level, presence of severe coronary artery stenosis, low left ventricular ejection fraction, low cardiac index (CI), large left ventricular mass, and use of beta-blockers proved to be significant risk factors for cardiovascular events. Further analysis by a stepwise regression analysis revealed that, older age (hazard ratio (HR)=1.42), low HDL cholesterol level (HR=0.877), presence of severe coronary artery stenosis (HR=49.32), and decreased CI (HR=14.18) proved to be independent prognostic factors. Ca antagonists were prescribed to 261 patients (89.4%). Among four Ca antagonists, there were significant differences in the frequency of cardiovascular events (2.6% with benidipine, 4.2% with nifedipine, 6.0% with diltiazem, 23.1% with amlodipine; amlodipine vs. benidipine, P<0.05) although the background characteristics of the four different patient groups were non-equivalent.
These results indicate that the morbidity of patients with vasospastic angina increased with older age, lower CI or HDL cholesterol, and presence of severe coronary artery stenosis, and that treatment with benidipine appeared to reduce cardiovascular events in patients with vasospastic angina.
本回顾性研究旨在阐明导致血管痉挛性心绞痛患者预后的相关因素。
对 292 例经冠状动脉血管痉挛证实为心绞痛的患者进行随访（平均随访 4.3+/-3.6 年），以确定包括治疗药物在内的各种临床因素与心血管事件发生之间的关系。心血管事件定义为致死性和非致死性心血管疾病事件。
包括年龄、肌酐水平升高、高密度脂蛋白（HDL）胆固醇水平低、严重冠状动脉狭窄、左心室射血分数低、心指数（CI）低、左心室质量大、β受体阻滞剂使用等在内的多种临床变量被证明是心血管事件的显著危险因素。通过逐步回归分析进一步分析显示，年龄较大（危险比（HR）=1.42）、HDL 胆固醇水平低（HR=0.877）、严重冠状动脉狭窄（HR=49.32）和 CI 降低（HR=14.18）被证明是独立的预后因素。261 例患者（89.4%）被处方钙拮抗剂。在四种钙拮抗剂中，心血管事件的发生频率存在显著差异（苯磺酸氨氯地平组为 2.6%、硝苯地平组为 4.2%、地尔硫䓬组为 6.0%、氨氯地平组为 23.1%；氨氯地平组与苯磺酸氨氯地平组相比，P<0.05），尽管这四个不同患者组的背景特征并不等效。
这些结果表明，血管痉挛性心绞痛患者的发病率随着年龄增长、CI 或 HDL 胆固醇降低以及严重冠状动脉狭窄的出现而增加，并且苯磺酸氨氯地平治疗可能会降低血管痉挛性心绞痛患者的心血管事件发生率。
