Beta blockers versus calcium channel blockers for provocation of vasospastic angina after drug-eluting stent implantation: a multicentre prospective randomised trial.

Abstract

BACKGROUND:

Drug-eluting stent-induced vasospastic angina (DES-VSA) has emerged as a novel complication in the modern era of percutaneous coronary intervention (PCI). Although beta blockers (BBs) are generally recommended for coronary heart disease, they may promote incidence of DES-VSA. This study aimed to compare the effects of calcium channel blockers (CCBs) perceived to be protective against DES-VSA and BBs on subsequent coronary events after second-generation drug-eluting stent implantation.

METHODS:

In this multicentre prospective, randomised study, 52 patients with coronary artery disease who underwent PCI for a single-vessel lesion with everolimus-eluting stent placement were randomised into post-stenting BB (N=26) and CCB (N=26) groups and followed for 24 months to detect any major cardiovascular events (MACE). A positive result on acetylcholine provocation testing during diagnostic coronary angiography (CAG) at 9 months was the primary endpoint for equivalence. MACE included all-cause death, non-fatal myocardial infarction, unstable angina, cerebrovascular disease or coronary revascularisation for stable coronary artery disease after index PCI.

RESULTS:

At 9 months, 42 patients (80.8%) underwent diagnostic coronary angiography and acetylcholine provocation testing. Among them, seven patients in each group were diagnosed with definite vasospasm (intention-to-treat analysis 26.9% vs 26.9%, risk difference 0 (-0.241, 0.241)). Meanwhile, the secondary endpoint, 24-month MACE, was higher in the CCB group (19.2%) than in the BB group (3.8%) (p=0.01). In detail, coronary revascularisation for stable coronary artery disease was the predominant endpoint that contributed to the greater proportion of MACE in the CCB group (CCB (19.2%) vs BB (3.8%), p=0.03).

CONCLUSIONS:

The incidence of acetylcholine-induced coronary artery spasms did not differ between patients receiving BBs or CCBs at 9 months after PCI. However, a higher incidence of 2-year MACE was observed in the CCB group, suggesting the importance of BB administration.

TRIAL REGISTRATION NUMBER:

This study was registered at the Japanese University Hospital Medical Information Network (UMIN) Clinical Trial Registry (The Prospective Randomized Trial for Optimizing Medical Therapy After Stenting: Calcium-Beta Trial; UMIN000008321, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000009536).

• Authors: Mitsuaki Sawano, Toshiomi Katsuki, Takeshi Kitai, Koichi Tamita, Kotaro Obunai, Yukinori Ikegami, Takafumi Yamane, Ikuko Ueda, Ayaka Endo, Yuichiro Maekawa, Akio Kawamura, Keiichi Fukuda, Shun Kohsaka
• Journal: Open heart (Open Heart) Vol. 7 Issue 2 (10 2020) ISSN: 2053-3624 [Print] England
• PMID: 33087441 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Adrenergic beta-Antagonists
• Calcium Channel Blockers

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Aged
• Aged, 80 and over
• Angina Pectoris (diagnostic imaging, epidemiology, prevention & control)
• Calcium Channel Blockers (therapeutic use)
• Coronary Artery Disease (diagnostic imaging, epidemiology, therapy)
• Coronary Vasospasm (diagnostic imaging, epidemiology, prevention & control)
• Drug-Eluting Stents
• Female
• Humans
• Incidence
• Japan (epidemiology)
• Male
• Middle Aged
• Percutaneous Coronary Intervention (adverse effects, instrumentation)
• Prospective Studies
• Protective Factors
• Risk Assessment
• Risk Factors
• Time Factors
• Treatment Outcome