title: Impact of Renin-Angiotensin System Inhibitors on Long-Term Clinical Outcomes of Patients With Coronary Artery Spasm.
abstract: 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.
  
  
  
  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.
  
  
  
  Chronic RAS inhibitor therapy was associated with lower incidence of cardiovascular events in VSA patients in the 5-year clinical follow-up.
authors.affiliation: Department of Medicine, Korea University Graduate School, Seoul, Korea.
authors.forename: Byoung Geol
authors.initials: BG
authors.lastname: Choi
authors.affiliation: Department of Medicine, Korea University Graduate School, Seoul, Korea.
authors.forename: Sung Yeon
authors.initials: SY
authors.lastname: Jeon
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea swrha617@yahoo.co.kr matsalong@hanmail.net.
authors.forename: Seung-Woon
authors.initials: SW
authors.lastname: Rha
authors.affiliation: Cardiology Department, Soonchunhyang University Cheonan Hospital, Cheonan, Korea swrha617@yahoo.co.kr matsalong@hanmail.net.
authors.forename: Sang-Ho
authors.initials: SH
authors.lastname: Park
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Min Suk
authors.initials: MS
authors.lastname: Shim
authors.affiliation: Department of Medicine, Korea University Graduate School, Seoul, Korea.
authors.forename: Se Yeon
authors.initials: SY
authors.lastname: Choi
authors.affiliation: Department of Medicine, Korea University Graduate School, Seoul, Korea.
authors.forename: Jae Kyeong
authors.initials: JK
authors.lastname: Byun
authors.affiliation: Department of Medicine, Korea University Graduate School, Seoul, Korea.
authors.forename: Hu
authors.initials: H
authors.lastname: Li
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Jah Yeon
authors.initials: JY
authors.lastname: Choi
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Eun Jin
authors.initials: EJ
authors.lastname: Park
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Sung-Hun
authors.initials: SH
authors.lastname: Park
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Jae Joong
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Sunki
authors.initials: S
authors.lastname: Lee
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Jin Oh
authors.initials: JO
authors.lastname: Na
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Cheol Ung
authors.initials: CU
authors.lastname: Choi
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Hong Euy
authors.initials: HE
authors.lastname: Lim
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Jin Won
authors.initials: JW
authors.lastname: Kim
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Eung Ju
authors.initials: EJ
authors.lastname: Kim
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Chang Gyu
authors.initials: CG
authors.lastname: Park
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Hong Seog
authors.initials: HS
authors.lastname: Seo
authors.affiliation: Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
authors.forename: Dong Joo
authors.initials: DJ
authors.lastname: Oh
mesh_terms: D000109:Acetylcholine; D000368:Aged; D000788:Angina Pectoris, Variant / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002423:Cause of Death; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009566:Nitrates / Q000627:therapeutic use; D062645:Percutaneous Coronary Intervention; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome; D014665:Vasodilator Agents
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D009566:Nitrates; D014665:Vasodilator Agents; D000109:Acetylcholine
keywords: acetylcholine; angina; angiotensin converting enzyme inhibitor; angiotensin receptor blocker; coronary artery spasm; renin–angiotensin system; vasospasm