Influential Factors for Long-term Prognosis in Patients with Vasospastic Angina Sunao Kodama 1 , Yukiko Inoue 1 , Hiroyuki Mihara 1 , Syunichiro Sumi 1 , Keiko Kudo 1 , Keisuke Okamura 1 , Chie Ando 1 , Hideya Niimura 1 , Yoshihiro Tsuchiya 1 , Yoshio Yamanouchi 1 , Hidenori Urata 1 1Department of Cardiovascular Diseases, Fukuoka University Chikushi Hospital Keyword: 冠攣縮性狭心症 , 長期予後 , ベニジピン , vasospastic angina , long-term prognosis , benidipine hydrochloride pp.1157-1164
Published Date 2007/10/15
DOI https://doi.org/10.11477/mf.1404100909
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The aim of the present study was to investigate the relationship between the long-term outcome of vasospastic angina(VSA) and the factor influencing its prognosis, including clinical characteristics and treatments. A total of 292 patients with VSA were followed up, and analyzed for predictors of coronary vascular events. The univariate analysis revealed that high age, elevated creatinine level, low HDL-choresterol level, presence of significant coronary stenosis, decreased left ventricular ejection fraction(LVEF: <45%), decreased cardiac index(CI: <2.5l/min/m2), increased left ventricular mass(LVmass: >150g/m2) and use of beta-blockers proved to be significant factors leading to poor prognosis. Four independent prognostic factors were shown by multivariate analysis with Cox proportional hazards model. They were high age(hazards rate; HR=1.42), low HDL-cholesterol level(HR=0.877), presence of significant coronary stenosis(HR=49.32) and decreased CI(HR=14.18). Two hundred and sixty-one patients(89.4%) were treated with calcium channel blockers: diltiazem at 152 pts, benidipine at 78 pts, nifedipine at 24 pts and amlodipine at 13 pts. Among the calcium channel blockers, the patients treated with benidipine had the lowest incidences of coronary vascular events. The incidence rate of coronary vascular events was 2.6% for benidipine, 4.2% for nifedipine, 6.0% for diltiazem and 23.1% for amlodipine. Benidipine showed a significantly better prognostic effect in patients with VSA than amlodipine. These results demonstrate that the influential factors for long-term prognosis of patients of VSA were high age, low CI or HDL-cholesterol and significant coronary stenosis, and they suggest the importance of management for lipid metabolism and arteriosclerosis. Although calcium channel blockers were frequently used in patients with VSA, only benidipine seemed effective for a good outcome.

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