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

Autor: Kim CH; Division of Cardiology, Department of Internal Medicine, Hyemin General Hospital, Seoul, Republic of Korea., Park TK; Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea., Cho SW; Division of Cardiology, Department of Internal Medicine, Inje University, College of Medicine, Seoul Paik Hospital, Seoul, Republic of Korea., Oh MS; Cardiovascular Center, Department of Internal Medicine, Bundang Jesaeng Hospital, Daejin Medical Center, Gyeonggi-do, Republic of Korea., Lee DH; Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea., Seong CS; Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea., Gwag HB; Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea., Lim AY; Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea., Yang JH; Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea., Song YB; Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea., Hahn JY; Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea., Choi JH; Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea., Lee SH; Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea., Gwon HC; Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea., Ahn J; Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea., Carriere KC; Department of Biostatistics and Clinical Epidemiology, Samsung Medical Center, Seoul, Republic of Korea; Department of Mathematical and Statistical Sciences, University of Alberta, Edmonton, Alberta, Canada., Choi SH; Division of Cardiology, Department of Internal Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Republic of Korea. Electronic address: cardiochoi@skku.edu.
Jazyk: angličtina
Zdroj: International journal of cardiology [Int J Cardiol] 2018 Feb 01; Vol. 252, pp. 1-5.
DOI: 10.1016/j.ijcard.2017.07.031
Abstrakt: 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. We investigated the prognostic impact of chronic nitrate therapy in VSA patients.
Methods: Between January 2003 and December 2014, a total of 1154 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 1.80, 95%CI 1.35-2.39, p<0.001) or were administered any forms of ISMN other than at bedtime (HR 1.90, 95%CI 1.41-2.57, 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 1.11, 95%CI 0.73-1.69, p=0.62).
Conclusions: 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.
(Copyright © 2017 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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