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Impact of different nitrate therapies on long-term clinical outcomes of patients with vasospastic angina: a propensity score-matched analysis

Session Poster session 1

Speaker Seung-Hyuk Choi

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : TK Park (Seoul,KR), JH Yang (Seoul,KR), YB Song (Seoul,KR), JY Hahn (Seoul,KR), JH Choi (Seoul,KR), SH Choi (Seoul,KR), SH Lee (Seoul,KR), HC Gwon (Seoul,KR)

T.K. Park1 , J.H. Yang1 , Y.B. Song1 , J.Y. Hahn1 , J.H. Choi1 , S.H. Choi1 , S.H. Lee1 , H.C. Gwon1 , 1Samsung Medical Center, Division of Cardiology, Department of Medicine - Seoul - Korea Republic of ,

European Heart Journal ( 2017 ) 38 ( Supplement ), 192

Background: Despite the short-term vasodilatory effects of nitrates, the prognostic effects of long-term nitrate therapy in patients with vasospastic angina (VSA) remains unclear.

Purpose: We investigated the prognostic impact of chronic nitrate therapy in VSA patients.

Methods: Between January 2003 and December 2014, a total of 1,154 VSA patients proven by ergonovine provocation tests were classified into nitrate (n=676) and non-nitrate (n=478) groups according to prescriptions for oral nitrates, including isosorbide mononitrate (ISMN) and nicorandil. The primary outcome was major adverse cardiovascular events (MACE), defined as a composite of cardiac death, myocardial infarction, any revascularization, or rehospitalization due to recurrent angina.

Results: The nitrate group was found to have a higher risk of MACE (22.9% vs. 17.6%, hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.01–1.73, p=0.043) than the non-nitrate group. After propensity score matching, the nitrate group had greater risks of MACE (HR 1.32, 95% CI 1.01–1.73, p=0.049). Patients who received the immediate-release formula of ISMN (HR 1.66, 95% CI 1.23–2.23, p=0.001) or were administered any forms of ISMN other than at bedtime (HR 1.67, 95% CI 1.22–2.27, p=0.001) had a significantly higher risk of MACE compared with the non-nitrate group. Nicorandil was shown to have a neutral effect on VSA patients (HR 1.01, 95% CI 0.69–1.50, p=0.95).

Conclusion: The long-term use of nitrate therapy was associated with increased risk of adverse cardiac events in VSA patients. The use of immediate-release ISMN or the administration of ISMN other than at bedtime was related with poor outcomes of VSA patients.

Subgroup analysis for nitrate treatment

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