Second-generation calcium channel blockers did not significantly reduce the composite outcome of death, acute coronary syndrome, and symptomatic arrhythmia compared to first-generation agents (HR 0.54).
Cohort (n=1,586)
Yes
Does second generation CCBs reduce the composite of death, ACS, and symptomatic arrhythmia in patients with vasospastic angina compared to first generation CCBs?
Second-generation CCBs did not significantly reduce the primary composite outcome compared to first-generation CCBs in vasospastic angina, but were associated with a lower incidence of ACS and better angina symptom control.
Hazard Ratio: 0.54 (95% CI 0.25–1.17)
Absolute Event Rate: 2.9% vs 5.4%
p-value: p=0.120
BACKGROUND/AIMS: Calcium channel blockers (CCBs) are the most widely prescribed medication for patients with vasospastic angina (VA). However, few studies have compared the prognosis of VA patients who are prescribed different CCBs. METHODS: We enrolled 2,960 patients who received provocation test prospectively in 11 university hospitals in Korea. We divided 1,586 patients received four major CCBs into two groups: a first generation CCB (diltiazem and nifedipine) group and a second generation CCB (amlodipine and benidipine) group. Primary outcome was time to events of composite of death from any cause, acute coronary syndrome (ACS) and symptomatic arrhythmia during 3-year follow-up. We also compared the effect of each CCB on the control of angina symptoms. RESULTS: There was no difference of the primary outcome among the two groups with a cumulative incidence rate of 5.4%, 2.9%, and a person-month incidence rate of 2.33 and 1.26, respectively (hazard ratio HR, 0.54; 95% confidence interval CI, 0.25 to 1.17; p = 0.120, as reference with the 1st generation CCBs). The incidence of ACS was significantly lower in 2nd generation CCBs group with a person-month incidence rate of 1.66 vs. 0.35 (HR, 0.22; 95% CI, 0.05 to 0.89; p = 0.034). Use of benidipine showed a significant better control of angina symptom compared with diltiazem for 3 years (odds ratio, 0.17; 95% CI, 0.09 to 0.32; p < 0.0001 at 3rd year). CONCLUSION: The first and second generation CCB groups did not differ in terms of composite outcome occurrence. However, the ACS incidence rate was significantly lower in the users of the 2nd generation CCBs.
Kim et al. (Mon,) conducted a cohort in Vasospastic angina (n=1,586). Second-generation calcium channel blockers (amlodipine and benidipine) vs. First-generation calcium channel blockers (diltiazem and nifedipine) was evaluated on Composite of death from any cause, acute coronary syndrome, and symptomatic arrhythmia (HR 0.54, 95% CI 0.25 to 1.17, p=0.120). Second-generation calcium channel blockers did not significantly reduce the composite outcome of death, acute coronary syndrome, and symptomatic arrhythmia compared to first-generation agents (HR 0.54).