Korean J Intern Med.  2021 Jan;36(1):124-134. 10.3904/kjim.2019.308.

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

Affiliations
  • 1Department of Cardiovascular Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Korea
  • 2Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
  • 3Department of Cardiovascular Medicine, Gachon University Gil Medical Center, Incheon, Korea
  • 4Department of Cardiovascular Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
  • 5Department of Cardiovascular Medicine, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
  • 6Department of Cardiovascular Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
  • 7Department of Epidemiology and Occupational Medicine, Dong-A University College of Medicine, Busan, Korea
  • 8Department of Cardiovascular Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea

Abstract

Background/Aims
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.
Methods
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.
Results
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).
Conclusions
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.

Keyword

Coronary vasospasm; Calcium channel blockers; Patient outcome assessment
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