Abstract
BackgroundThe interaction between smoking and the use of antiplatelet agents on the prognosis of vasospastic angina (VA) is rarely investigated.MethodsVA-Korea is a nation-wide multi-center registry with prospective design (n = 1812). The primary endpoint was the composite occurrence of acute coronary syndrome (ACS), symptomatic arrhythmia, and cardiac death. Log-rank test and Cox proportional hazard model were for statistical analysis. Also, we conducted interaction analysis in both additive and multiplicative scales between smoking and antiplatelet agents among VA patients. For additive scale interaction, relative excess risk due to interaction (RERI) was calculated and for multiplicative scale interaction, the ratio of hazard ratio (HR) was calculated. All statistical analysis conducted by Stata Ver 16.1.ResultsPatients who were smoking and using antiplatelet agents had the highest incidence rate in the primary composite outcome. The incidence rate was 3.49 per 1,000 person-month (95% CI: 2.30-5.30, log-rank test for primary outcome p = 0.017) and HR of smoking and using antiplatelet agents was 1.66 (95%CI: 0.98-2.81). The adjusted RERI of smoking and using antiplatelet agents was 1.10 (p = 0.009), and the adjusted ratio of HR of smoking and using antiplatelet agents was 3.32 (p = 0.019). The current study observed the interaction between smoking and using antiplatelet agents in both additive and multiplicative scales.ConclusionsSmoking was associated with higher rates of unfavorable clinical outcomes among VA patients taking antiplatelet agents. This suggested that VA patients, especially those using antiplatelet agents should quit smoking.
Highlights
The prognosis of vasospastic angina (VA) is known to be better than acute coronary syndrome (ACS)
The incidence rate was 3.49 per 1,000 person-month and hazard ratio (HR) of smoking and using antiplatelet agents was 1.66 (95%confidence interval (CI): 0.98-2.81)
Smoking was associated with higher rates of unfavorable clinical outcomes among VA patients taking antiplatelet agents
Summary
The prognosis of vasospastic angina (VA) is known to be better than acute coronary syndrome (ACS). Previous studies showed that angina at rest, ST-segment elevation during angina, coronary arterial stenosis were linked with worse prognosis among VA patients [1, 2]. Antiplatelet agents have been used for primary prevention of cardiovascular disease among high risk patients of coronary artery disease (CAD) like diabetes [3]. Antiplatelet agents are usually prescribed for secondary prevention for those with combined atherosclerotic CAD or receiving percutaneous coronary intervention (PCI) in VA patients. The use of antiplatelet agents, even low dose aspirin, showed controversial results on the prognosis of patients with VA [4,5,6,7]. The interaction between smoking and the use of antiplatelet agents on the prognosis of vasospastic angina (VA) is rarely investigated
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