2021 Volume 5 Issue 1 Pages 13-22
Background: A systematic review and meta-analysis was conducted to assess the most effective treatment (long-term administration of calcium channel blockers [CCBs] with and without any form of long-acting nitrates [nitrates]) for reducing the incidence of major adverse cardiac events (MACEs) in patients with vasospastic angina (VSA).
Methods: We comprehensively searched MEDLINE (PubMed) and Japan Medical Abstracts Society (ICHUSHI) databases in August 2020 for eligible studies examining the impact of any CCBs with and without nitrates on MACEs in patients with VSA angiographically diagnosed using intracoronary provocation tests. MACE was defined as a composite of cardiac death, nonfatal myocardial infarction, unstable angina, admission due to medically resistant chest pain, and operation of an implantable cardioverter-defibrillator.
Results: Among the 10,278 studies, five studies (four from Japan and one from South Korea) reporting hazard ratios by adjusting the baseline factors using the Cox proportional hazard model and propensity-score matched analysis were selected. In total, 3,640 patients treated with CCBs (any CCBs without nitrates group; n = 2,104) and CCBs plus nitrates (CCBs plus nitrates group, n = 1,536) for a mean follow-up duration of 32-70.5 months were enrolled. MACEs occurred in 323 (8.9%) patients. The CCBs plus nitrates group had a higher risk of MACEs than the any CCBs without nitrates group (risk ratio, 1.51; 95% confidence interval, 1.13-2.01; heterogeneity I2 = 42.9%; p = 0.13) in the random-effects model.
Conclusions: Long-term use of CCBs with nitrates did not improve the prognosis in Japanese and South Korean patients with VSA compared to that with long-term use of any CCBs without nitrates.
