Key result
Antiplatelet therapy shows no benefit over no therapy for MACE in vasospastic angina.
Why the study?
Antiplatelet therapy is generally used in coronary artery disease, but its impact in patients with vasospastic angina is not fully understood.
Does antiplatelet therapy reduce major adverse cardiac events in patients with vasospastic angina?
Cohort (n=1,429)
Yes
Does antiplatelet therapy reduce major adverse cardiac events in patients with vasospastic angina?
Antiplatelet therapy did not provide a significant clinical benefit in preventing adverse cardiac events among patients with vasospastic angina in this registry.
Antiplatelet therapy was not associated with reduced MACE in vasospastic angina; leaves open its role pending randomized trials.
BACKGROUND: Antiplatelet therapy (APT) is generally used in patients with coronary artery disease. However, for patients with vasospastic angina (VSA), the impact of APT is not fully understood. METHODS: In a multicenter registry study of the Japanese Coronary Spasm Association (n = 1429), patients with or without APT were compared. The primary endpoint was major adverse cardiac events (MACEs), defined as cardiac death, non-fatal myocardial infarction, unstable angina, heart failure and appropriate ICD (Implantable cardioverter defibrillator) shock. Propensity score matching and a multivariable cox proportional hazard model were used to adjust for selection bias for treatment and potential confounding factors. RESULTS: In the whole population, 669 patients received APT, while 760 patients did not receive APT. Patients with APT had a greater prevalence of comorbidities, such as hypertension, diabetes, dyslipidemia and smoking, than those without APT. The prevalences of previous myocardial infarction, spontaneous ST changes, significant organic stenosis and medications including calcium channel blocker, nitrate, statin and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker were greater in patients with APT than those without APT. After propensity matching (n = 335 for both groups), during the median follow-up period of 32 months, the incidence rate of MACE was comparable between the patients with and without APT (P = 0.24). MACEs occurred in 5.7% of patients with APT and in 3.6% of those without APT (P = 0.20). All-cause death occurred in 0.6% of patients with APT and 1.8% of those without APT (p = 0.16). CONCLUSION: In this multicenter registry study, anti-platelet therapy exerted no beneficial effects for VSA patients.
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Mori et al. (2020) conducted a cohort in Vasospastic angina (n=1,429). Antiplatelet therapy vs. No antiplatelet therapy was evaluated on Major adverse cardiac events (MACEs) defined as cardiac death, non-fatal myocardial infarction, unstable angina, heart failure and appropriate ICD shock (p=0.20). Antiplatelet therapy showed no significant difference in the incidence of major adverse cardiac events compared to no antiplatelet therapy in patients with vasospastic angina (5.7% vs 3.6%, p=0.20).
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