Background: Although calcium channel blockers (CCB) are highly effective for suppression of vasospastic angina (VSA) attacks, their prognostic effects in VSA patients remain to be examined in a large number of patients.
Methods and Results:Databases for related papers were searched and then a meta-analysis regarding the effects of CCB on major adverse cardiovascular events (MACE) in Japanese VSA patients with the 4 previous studies was performed. A total of 1,997 patients with positive coronary spasm provocation tests were evaluated. They were treated with either alone or combination of benidipine (n=320), amlodipine (n=308), nifedipine (n=182) or diltiazem (n=960). MACE were observed in 143 patients (cardiac death: 36, myocardial infarction: 51, heart failure: 26, stroke: 65, and aortic aneurysm: 11). The hazard ratio for the occurrence of MACE was significantly lower in patients treated with benidipine than in those with diltiazem. There was no significant difference in the clinical characteristics affecting the occurrence of MACE among the 4 CCB groups. Furthermore, the hazard ratio for the occurrence of MACE was significantly lower in those treated with benidipine, even after correction for patient characteristics that could have affected the occurrence of MACE (hazard ratio 0.41, P=0.016).
Conclusions:These results suggest that among the 4 major CCB that effectively suppress VSA attacks in general, benidipine showed significantly more beneficial prognostic effects than others. (Circ J 2010; 74: 1943 - 1950
Methods
Study Eligibility Criteria and Search StrategyWe searched the database of MEDLINE ® for papers published in English from 1950 to December, 2008 and the Japana Centra Revuo Medicina (Ichushi ® ) for papers published in Japanese with an English abstract from 1983 to December, 2008. The keywords used were 16 CCB (nifedipine, nicardipine, nisoldipine, nitrendipine, nilvadipine, manidipine, benidipine, amlodipine, barnidipine, efonidipine, felodipine, clinidipine, aranidipine, azelnidipine, diltiazem, or verapamil), prognosis, and VSA and related terms (vasospasm, coronary VSA, rest angina, variant angina). The papers in Japanese were restricted to those with an English abstract. Among the 11,636 papers in English searched by the database of MEDLINE ® , 2 papers were finally selected, in which the effects of CCB on the occurrence of MACE in VSA patients were compared ( Figure 1A). 10,11 In addition, 2 papers in Japanese were selected 12,13 among the 6,315 papers searched