Prognostic factors for the long-term survival in patients with vasospastic angina--analysis of effects of patients' characteristics and therapeutic drugs.
OBJECTIVE
A retrospective study was conducted to elucidate contributing factors on the outcome of patients with vasospastic angina.


METHODS
Two hundred ninety-two patients with angina in whom coronary vasospasm was documented were followed up (mean 4.3+/-3.6 years) to determine the relationship between the occurrence of cardiovascular events with available clinical factors including therapeutic drugs. Cardiovascular events were defined as fatal and non-fatal cardiovascular disorder events.


RESULTS
Several clinical variables including age, elevated creatinine level, low high-density lipoprotein (HDL) cholesterol level, presence of severe coronary artery stenosis, low left ventricular ejection fraction, low cardiac index (CI), large left ventricular mass, and use of beta-blockers proved to be significant risk factors for cardiovascular events. Further analysis by a stepwise regression analysis revealed that, older age (hazard ratio (HR)=1.42), low HDL cholesterol level (HR=0.877), presence of severe coronary artery stenosis (HR=49.32), and decreased CI (HR=14.18) proved to be independent prognostic factors. Ca antagonists were prescribed to 261 patients (89.4%). Among four Ca antagonists, there were significant differences in the frequency of cardiovascular events (2.6% with benidipine, 4.2% with nifedipine, 6.0% with diltiazem, 23.1% with amlodipine; amlodipine vs. benidipine, P<0.05) although the background characteristics of the four different patient groups were non-equivalent.


CONCLUSIONS
These results indicate that the morbidity of patients with vasospastic angina increased with older age, lower CI or HDL cholesterol, and presence of severe coronary artery stenosis, and that treatment with benidipine appeared to reduce cardiovascular events in patients with vasospastic angina.
Kodama
Sunao
S
Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin Chikushino-shi, 818-8502 Fukuoka, Japan.
Inoue
Yukiko
Y
Mihara
Hiroyuki
H
Sumi
Syunichiro
S
Kudo
Keiko
K
Okamura
Keisuke
K
Ando
Chie
C
Niimura
Hideya
H
Tsuchiya
Yoshihiro
Y
Yamanouchi
Yoshio
Y
Urata
Hidenori
H
D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D002121:Calcium Channel Blockers / Q000627:therapeutic use*; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015996:Survival Rate
D002121:Calcium Channel Blockers