Key result
Discharge nitrates linked to ~2.4-fold higher 1-year adverse events vs. other vasodilators.
Why the study?
Vasodilators are widely used in patients with vasospastic angina, but few studies have compared the long-term prognostic effects of different types of vasodilators.
Does the use of nitrates at discharge compared to other vasodilators increase the rate of composite clinical events in patients with vasospastic angina?
Cohort (n=1,048)
Yes
Does the use of nitrates at discharge compared to other vasodilators increase the rate of composite clinical events in patients with vasospastic angina?
In patients with vasospastic angina, discharging on nitrates rather than other vasodilators like nicorandil is associated with an increased 1-year risk of composite adverse clinical events.
Answers are grounded in this paper and cite their sources.
Nitrates at discharge were associated with higher adverse events in vasospastic angina; leaves open whether randomized trials will confirm this association.
Although vasodilators are widely used in patients with vasospastic angina (VA), few studies have compared the long-term prognostic effects of different types of vasodilators. We investigated the long-term effects of vasodilators on clinical outcomes in VA patients according to the type of vasodilator used. Study data were obtained from a prospective multicenter registry that included patients who had symptoms suggestive of VA. Patients were classified into two groups according to use of nitrates (n = 239) or other vasodilators (n = 809) at discharge. The composite clinical events rate, including acute coronary syndrome (ACS), cardiac death, new-onset arrhythmia (including ventricular tachycardia and ventricular fibrillation), and atrioventricular block, was significantly higher in the nitrates group (5.3% vs. 2.2%, p = 0.026) during one year of follow-up. Specifically, the prevalence of ACS was significantly more frequent in the nitrates group (4.3% vs. 1.5%, p = 0.024). After propensity score matching, the adverse effects of nitrates remained. In addition, the use of nitrates at discharge was independently associated with a 2.69-fold increased risk of ACS in VA patients. In conclusion, using nitrates as a vasodilator at discharge can increase the adverse clinical outcomes in VA patients at one year of follow-up. Clinicians need to be aware of the prognostic value and consider prescribing other vasodilators.
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Kim et al. (2022) conducted a cohort in Vasospastic angina (n=1,048). Nitrates vs. Other vasodilators (nicorandil, molsidomine, or trimetazidine) was evaluated on Composite of acute coronary syndrome, cardiac death, new-onset arrhythmia, and atrioventricular block at 1 year (p=0.026). Prescription of nitrates at discharge was associated with a significantly higher 1-year rate of composite adverse clinical events compared to other vasodilators (5.3% vs. 2.2%, p=0.026).
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