Impact of Renin‐Angiotensin System Inhibitors on Long‐Term Clinical Outcomes of Patients With Coronary Artery Spasm

Abstract

Background Coronary artery spasm ( CAS ) is a well‐known endothelial dysfunction, and a major cause of vasospastic angina ( VSA ). The renin–angiotensin system ( RAS ) is known to be closely associated with endothelial function. However, there are only a few studies that investigated the impact of RAS inhibitor on long‐term clinical outcomes in VSA patients. Methods and Results A total of 3349 patients with no significant coronary artery disease, diagnosed with CAS by acetylcholine provocation test were enrolled for this study. Significant CAS was defined as having ≥70% narrowing of the artery after incremental injections of 20, 50, and 100 μg of acetylcholine into the left coronary artery. Patients were divided into 2 groups according to whether the prescription included RAS inhibitor or not ( RAS inhibitor group: n=666, non‐ RAS inhibitor group; n=2683). To adjust for any potential confounders that could cause bias, propensity score matching ( PSM ) analysis was performed using a logistic regression model. After PSM analysis, 2 matched groups (524 pairs, n=1048 patients, C‐statistic=0.845) were generated and their baseline characteristics were balanced. During the 5‐year clinical follow‐up, the RAS inhibitor group showed a lower incidence of recurrent angina (8.7% versus 14.1%, P =0.027), total death (0.0% versus 1.3%, P =0.045), and total major adverse cardiovascular events (1.0% versus 4.1%, P =0.026) than the non‐ RAS inhibitor group. Conclusions Chronic RAS inhibitor therapy was associated with lower incidence of cardiovascular events in VSA patients in the 5‐year clinical follow‐up.