Roughly 40% of patients receiving a coronary angiography for stable angina (angina episodes twice a week despite medical treatment, lasting 3 months) do not present obstructive coronary artery disease (ANOCA). Between 60 to 90% is due to coronary vasomotor dysfunction (CVDys) which might be interpreted as vessel spasm or microvascular dysfunction.
A recent publication from the European Society of Cardiology about ANOCA recommends the use of several drugs such as calcium blockers, beta blockers, ACE inhibitors, statins or nitric acid modulators.
The study EDIT-CMD looked into the effect of diltiazem in the treatment of coronary vasomotor dysfunction compared vs placebo in patients with ANOCA, through coronary function testing. (CFT).
A randomized study was carried out, double blind, including 85 patients, mean age 58, receiving a CFT, consisting of a diagnostic coronary angiography, a spasm provoking test with acetylcholine and a microvascular function test with adenosine. Primary end point was treatment success defined as normalization of at least one abnormal CVDys parameter at 6 months.
Read also: ACC 2022 – Complete Trial QoL: Complete Revascularization in STEMI.
The primary end point was observed in 21% of patients in the diltiazem group vs. 29% in the placebo group, with non-significant reduction (p=0.46). For both the more positive scenario and the negative, the use of diltiazem did not show important therapeutical success. 47% of patients in the intervention branch progressed from epicardial to microvascular spasm compared against 6% in the placebo group.
Conclusions
This is the first randomized study to look at the effect of CVDys in patients with ANOCA, and it’s concluded that diltiazem does not reduce coronary vasospasm and does not improve microvascular angina or quality of life.
Dr. Omar Tupayachi.
Member of the Editorial Board, SOLACI.org
Original Title: EDIT-CMD: Efficacy of Diltiazem to improve coronary vasomotor dysfunction in angina and nonobstructive coronary arteries (ANOCA): Results of the EDIT-CMD randomized clinical trial.
Reference: Jansen, T. P. J., Konst, R. E., de Vos, A., Paradies, V., Teerenstra, S., van den Oord, S. C. H., Dimitriu-Leen, A., Maas, A. H. E. M., Smits, P. C., Damman, P., van Royen, N., & Elias-Smale, S. E. (2022). Efficacy of Diltiazem to improve coronary vasomotor dysfunction in angina and nonobstructive coronary arteries (ANOCA): Results of the EDIT-CMD randomized clinical trial. JACC. Cardiovascular Imaging. https://doi.org/10.1016/j.jcmg.2022.03.012.
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