Prognostic impact of nitrate therapy in patients with myocardial bridge and coexisting coronary artery spasm.
Ji Bak KimByoung Geol ChoiSeung Woon RhaPublished in: Heart and vessels (2022)
The aim of this study was to investigate the prognostic impact of nitrate therapy in patients with myocardial bridge (MB) and coexisting coronary artery spasm (CAS). MB often accompanies CAS. Nitrates have been widely used as anti-ischemic drugs in CAS patients, while it is not recommended in MB patients. Thus, we investigated the long-term impact of nitrate on clinical outcomes in patients with both CAS and MB. A retrospective observational study was performed using propensity score matching (PSM) in a total of 757 consecutive MB patients with positive acetylcholine (Ach) provocation test. Patients were divided into two groups according to the regular administration of nitrates (nitrate group: n = 504, No nitrate group; n = 253). The PSM was used to adjust for selection bias and potential confounding factors, and major clinical outcomes were compared between the two groups up to 5 years. Baseline characteristics were well-matched between the two groups following PSM (n = 211 for both groups). There was no significant difference in the incidence of death, myocardial infarction, and major adverse cardiovascular events (MACEs) between the two groups. However, the nitrate group showed a significantly higher rate of recurrent angina which subsequently needed re-evaluation of coronary arteries by follow-up angiography (15.7 vs. 5.7%, Log-rank p = 0.012) compared to the non-nitrate group. Long-term nitrate administration in patients with MB and coexisting CAS did not show benefit in reducing MACE, rather it was associated with a higher incidence of recurrent angina requiring follow-up angiography.
Keyphrases
- coronary artery
- nitric oxide
- end stage renal disease
- drinking water
- crispr cas
- coronary artery disease
- ejection fraction
- cardiovascular events
- genome editing
- chronic kidney disease
- newly diagnosed
- computed tomography
- left ventricular
- cardiovascular disease
- stem cells
- emergency department
- risk factors
- type diabetes
- heart failure
- optical coherence tomography
- patient reported outcomes
- risk assessment
- brain injury
- oxidative stress
- cerebral ischemia
- blood brain barrier
- transcatheter aortic valve replacement
- single molecule
- patient reported