Nitrates vs. Other Types of Vasodilators and Clinical Outcomes in Patients with Vasospastic Angina: A Propensity Score-Matched Analysis

• Published in: Journal of clinical medicine Vol. 11; no. 12; p. 3250
• Main Authors: Kim, Hyun-Jin, Jo, Sang-Ho, Lee, Min-Ho, Seo, Won-Woo, Kim, Hack-Lyoung, Lee, Kwan Yong, Yang, Tae-Hyun, Her, Sung-Ho, Lee, Byoung-Kwon, Park, Keun-Ho, Ahn, Youngkeun, Rha, Seung-Woon, Gwon, Hyeon-Cheol, Choi, Dong-Ju, Baek, Sang Hong
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 07.06.2022; MDPI
• Subjects: Acute coronary syndromes; Angina pectoris; Cardiac arrhythmia; Cardiovascular disease; Clinical medicine; Clinical outcomes; Coronary vessels; Electrocardiography; Hemodynamics; Medical prognosis; Nitrates; Patients; Regression analysis; Smooth muscle; Survival analysis
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm11123250

Although vasodilators are widely used in patients with vasospastic angina (VA), few studies have compared the long-term prognostic effects of different types of vasodilators. We investigated the long-term effects of vasodilators on clinical outcomes in VA patients according to the type of vasodilator used. Study data were obtained from a prospective multicenter registry that included patients who had symptoms suggestive of VA. Patients were classified into two groups according to use of nitrates (n = 239) or other vasodilators (n = 809) at discharge. The composite clinical events rate, including acute coronary syndrome (ACS), cardiac death, new-onset arrhythmia (including ventricular tachycardia and ventricular fibrillation), and atrioventricular block, was significantly higher in the nitrates group (5.3% vs. 2.2%, p = 0.026) during one year of follow-up. Specifically, the prevalence of ACS was significantly more frequent in the nitrates group (4.3% vs. 1.5%, p = 0.024). After propensity score matching, the adverse effects of nitrates remained. In addition, the use of nitrates at discharge was independently associated with a 2.69-fold increased risk of ACS in VA patients. In conclusion, using nitrates as a vasodilator at discharge can increase the adverse clinical outcomes in VA patients at one year of follow-up. Clinicians need to be aware of the prognostic value and consider prescribing other vasodilators.