Background: Vasospastic angina (VSA) is characterized by coronary spasm, which can be aggravated by vasoactive substances such as serotonin. Hypothesis Sarpogrelate, a selective serotonin receptor antagonist, and high-dose statin have some effects on the reduction of coronary spasm in patients with VSA.
Methods: We recruited 100 patients with angiographically confirmed VSA, and randomly assigned them into four groups: sarpogrelate with high-dose statin (Group A, n = 25), sarpogrelate with low-dose or no statin (Group B, n = 25), placebo with high-dose statin (Group C, n = 25), and placebo with low-dose or no statin (Group D, n = 25). The primary endpoint was the remission of coronary spasm on 1-year follow-up provocation test.
Results: The most common site of coronary spasm was left anterior descending artery (42%). Most patients (96%) took calcium channel blockers, and 46% were treated with vasodilators. Overall, 40% of patients reported no chest pain at 1 year, and 23% showed complete remission of coronary spasm on 1-year follow-up provocation test. No difference was observed in symptomatic and angiographically complete remission rate between the sarpogrelate and the placebo group. Although the apolipoprotein B level at the 1-year follow-up was significantly lower in the high-dose statin group, symptomatic and angiographic outcomes were not different according to statin intensity. Distal thrombolysis in myocardial infarction (TIMI) flow on initial provocation test was independently associated with angiographically complete remission.
Conclusions: Sarpogrelate or high-dose statin did not significantly improve the angiographic remission rate in patients with VSA. Distal TIMI flow on initial provocation test could predict the complete remission of coronary spasm at follow-up.
Keywords: coronary spasm; high-dose statin; remission; sarpogrelate; vasospastic angina.
© 2019 The Authors. Clinical Cardiology published by Wiley Periodicals, Inc.
Conflict of interest statement
The authors declare no potential conflict of interests.
Evaluation of Coronary Microvascular Function in Patients With Vasospastic AnginaH Teragawa et al. World J Cardiol 5 (1), 1-7. PMID 23390571.These findings suggest that microvascular coronary function may be preserved despite endothelial dysfunction of the epicardial coronary arteries in patients with VSA.
Sarpogrelate, a Selective 5-HT2A Serotonergic Receptor Antagonist, Inhibits Serotonin-Induced Coronary Artery Spasm in a Porcine ModelK Miyata et al. J Cardiovasc Pharmacol 35 (2), 294-301. PMID 10672864.Serotonin is one of the most important vasoactive substances and has been implicated in the pathogenesis of coronary artery spasm and of acute coronary syndrome. We have …
[Does Quinapril Improve Coronary Vasoconstriction in Vasospastic Angina?]H Anzai et al. J Cardiol 36 (6), 379-86. PMID 11190581. - Clinical TrialOur results did not indicate that quinapril had improved coronary vasoconstriction induced by acetylcholine in patients with vasospastic angina.
Myocardial Infarction With Non-Obstructive Coronary Arteries: A Focus on Vasospastic AnginaMA Beijk et al. Neth Heart J 27 (5), 237-245. PMID 30689112. - ReviewVasospastic angina (VSA) is considered a broad diagnostic category including documented spontaneous episodes of angina pectoris produced by coronary epicardial vasospasm …
Vasospastic Angina: A Literature Review of Current EvidenceF Picard et al. Arch Cardiovasc Dis 112 (1), 44-55. PMID 30197243. - ReviewVasospastic angina (VSA) is a variant form of angina pectoris, in which angina occurs at rest, with transient electrocardiogram modifications and preserved exercise capac …
Cited by 1 PubMed Central articles
Effect of Sarpogrelate and High-Dose Statin on the Reduction of Coronary Spasm in Vasospastic Angina: A Two by Two Factorial, Pilot Randomized StudySR Kim et al. Clin Cardiol 42 (10), 899-907. PMID 31339594.Sarpogrelate or high-dose statin did not significantly improve the angiographic remission rate in patients with VSA. Distal TIMI flow on initial provocation test could pr …
- Lanza GA, Careri G, Crea F. Mechanisms of coronary artery spasm. Circulation. 2011;124:1774‐1782. - PubMed
- Stern S, Bayes de Luna A. Coronary artery spasm: a 2009 update. Circulation. 2009;119:2531‐2534. - PubMed
- Beltrame JF, Crea F, Kaski JC, et al. The who, what, why, when, how and where of vasospastic angina. Circ J. 2016;80:289‐298. - PubMed
- Yasue H, Nakagawa H, Itoh T, Harada E, Mizuno Y. Coronary artery spasm‐‐clinical features, diagnosis, pathogenesis, and treatment. J Cardiol. 2008;51:2‐17. - PubMed
- Yasue H, Kugiyama K. Coronary spasm: clinical features and pathogenesis. Intern Med. 1997;36:760‐765. - PubMed