Comparison of calcium-channel blockers for long-term clinical outcomes in patients with vasospastic angina

Calcium channel blockers (CCBs) are the most widely prescribed medication for patients with vasospastic angina (VA). However, few studies have compared the prognosis of VA patients who are prescribed different CCBs. We enrolled 2,960 patients who received provocation test prospectively in 11 univers...

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Bibliographic Details
Published in:The Korean journal of internal medicine 2021-01, Vol.36 (1), p.124-134
Main Authors: Kim, Sung Eun, Jo, Sang-Ho, Han, Seung Hwan, Lee, Kwan Yong, Her, Sung Ho, Lee, Min-Ho, Seo, Won-Woo, Cho, Seong-Sik, Baek, Sang Hong
Format: Article
Language:English
Subjects:
calcium channel blockers
coronary vasospasm
Original
patient outcome assessment
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Summary:Calcium channel blockers (CCBs) are the most widely prescribed medication for patients with vasospastic angina (VA). However, few studies have compared the prognosis of VA patients who are prescribed different CCBs. We enrolled 2,960 patients who received provocation test prospectively in 11 university hospitals in Korea. We divided 1,586 patients received four major CCBs into two groups: a first generation CCB (diltiazem and nifedipine) group and a second generation CCB (amlodipine and benidipine) group. Primary outcome was time to events of composite of death from any cause, acute coronary syndrome (ACS) and symptomatic arrhythmia during 3-year follow-up. We also compared the effect of each CCB on the control of angina symptoms. There was no difference of the primary outcome among the two groups with a cumulative incidence rate of 5.4%, 2.9%, and a person-month incidence rate of 2.33 and 1.26, respectively (hazard ratio [HR], 0.54; 95% confidence interval [CI], 0.25 to 1.17; p = 0.120, as reference with the 1st generation CCBs). The incidence of ACS was significantly lower in 2nd generation CCBs group with a person-month incidence rate of 1.66 vs. 0.35 (HR, 0.22; 95% CI, 0.05 to 0.89; p = 0.034). Use of benidipine showed a significant better control of angina symptom compared with diltiazem for 3 years (odds ratio, 0.17; 95% CI, 0.09 to 0.32; p < 0.0001 at 3rd year). The first and second generation CCB groups did not differ in terms of composite outcome occurrence. However, the ACS incidence rate was significantly lower in the users of the 2nd generation CCBs.
ISSN:1226-3303
2005-6648
DOI:10.3904/kjim.2019.308