The Impact of Cilostazol in Refractory Vasospastic Angina

Introduction Refractory vasospastic angina (VSA) includes patients with disabling angina despite maximally tolerated calcium channel blocker and nitrate therapy. Randomised clinical trial evidence confirms the efficacy of cilostazol in refractory VSA, yet its use in real-world clinical practice is limited. This study evaluated the impact of cilostazol therapy on patient-reported outcomes in patients with refractory VSA. Methods Between June 2016 and May 2022, 15 consecutive refractory VSA patients were initiated on cilostazol (50mg twice daily), with baseline and 3-month responses assessed via the Seattle Angina Questionnaire (SAQ). The primary outcome was a clinically significant reduction in angina frequency (ie >10-point improvement in SAQ angina frequency score) at 3 months. Results A clinically significant reduction in angina frequency was reported in 13 patients (86%) at 3-months, with 3 (20%) becoming angina free. Moreover, over 3 months, median SAQ scores improved for angina frequency (25 [IQR 15,46] to 75 [30,82]), physical limitation (53 [44,67] to 83 [56,92]), and quality-of-life (17 [4,29] to 50 [35,58]). Additionally, a 54% reduction in angina-related emergency department presentations and 50% reduction in angina-related hospital admissions was noted. Minor medication-related adverse effects were experienced by 3 patients, with no serious adverse effects noted. Cilostazol was continued in 14 patients (93%) beyond the 3-month follow-up period. Conclusions In patients with refractory VSA, cilostazol is well tolerated, improves patient-reported outcomes, reduces healthcare utilisation, and thus is an effective therapy in real-world clinical practice.