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
Department of Medicine, Korea University Graduate School, Seoul, Korea.
Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
J Am Heart Assoc. 2016 Jul 21;5(7):e003217. doi: 10.1161/JAHA.116.003217.
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.
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.
Chronic RAS inhibitor therapy was associated with lower incidence of cardiovascular events in VSA patients in the 5-year clinical follow-up.
冠状动脉痉挛（CAS）是一种众所周知的内皮功能障碍，也是血管痉挛性心绞痛（VSA）的主要原因。已知肾素-血管紧张素系统（RAS）与内皮功能密切相关。然而，仅有少数研究探讨了RAS抑制剂对VSA患者长期临床结局的影响。
本研究纳入了3349例无显著冠状动脉疾病且经乙酰胆碱激发试验诊断为CAS的患者。显著CAS定义为在向左冠状动脉递增注射20、50和100μg乙酰胆碱后动脉狭窄≥70%。根据处方是否包含RAS抑制剂将患者分为两组（RAS抑制剂组：n = 666，非RAS抑制剂组；n = 2683）。为调整可能导致偏倚的任何潜在混杂因素，使用逻辑回归模型进行倾向评分匹配（PSM）分析。PSM分析后，生成了2个匹配组（524对，n = 1048例患者，C统计量 = 0.845），且它们的基线特征得到平衡。在5年的临床随访期间，RAS抑制剂组复发性心绞痛的发生率（8.7%对14.1%，P = 0.027）、总死亡率（0.0%对1.3%，P = 0.045）和主要不良心血管事件总发生率（1.0%对4.1%，P = 0.026）均低于非RAS抑制剂组。
在5年临床随访中，慢性RAS抑制剂治疗与VSA患者较低的心血管事件发生率相关。
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