Effect of statins on MACE in patients with coronary artery spasm: a meta-analysis

Abstract Background Coronary artery spasm (CAS) is characterized by the transient constriction of coronary arteries, leading to reduced blood flow and potentially severe cardiovascular events. Factors such as vascular inflammation, autonomic nerve dysfunction, and endothelial dysfunction have been implicated in the pathophysiology of CAS. Importantly, CAS can manifest in patients with or without concurrent atherosclerosis, impacting both epicardial coronary arteries and the microvascular system. Given its association with acute coronary syndrome, stable angina pectoris, and sudden cardiac death, a deeper understanding of CAS is crucial for improving patient outcomes Purpose The purpose of this meta-analysis is to systematically evaluate the impact of statin therapy on major adverse cardiovascular events (MACE) in patients diagnosed with CAS. Methods We conducted a thorough systematic search of the PubMed, Embase, and Cochrane databases to identify studies assessing the effects of statin therapy in patients with CAS. Data analysis employed a random-effects model to calculate pooled risk ratios (RR) for binary outcomes, accompanied by 95% confidence intervals (CI). To evaluate the influence of individual studies on the overall pooled results and heterogeneity, we performed a leave-one-out analysis. Additionally, we conducted a meta-regression analysis to explore the relationship between the mean age of participants and the duration of follow-up. Throughout our analyses, we prioritized the most adjusted data available to mitigate potential confounders. All statistical evaluations were performed using R version 4.4.2. Results Our meta-analysis included a total of eleven studies, encompassing a pooled population of 13,765 patients, of which 6,561 (47.6%) received statin therapy. The mean age of the participants ranged from 55 to 64 years, with follow-up durations varying from 1 to 7.4 years. The statin therapy group demonstrated a significant reduction in MACE compared to the non-statin group, with an RR of 0.71 (95% CI: 0.52 to 0.98; p=0.03; I²=58%; Figure 1). However, leave-one-out analyses excluding studies by Kosugi (2011), Nakogami (2013), Ishii (2016), Piao (2016), and Lee (2024) yielded non-significant results as shown in Figure 2. Furthermore, no significant correlation was observed between the incidence of MACE and either the mean age of participants or the duration of follow-up. Conclusion Our findings suggest that statin therapy reduces the incidence of MACE in patients with CAS. However, further studies are warranted to validate our results.Forest Plot for MACE Leave-one-out Analysis