Five-year major clinical outcomes according to severity of coronary artery spasm as assessed by intracoronary acetylcholine provocation test.

Abstract

BACKGROUND:

Long-term clinical outcome data according to severity of coronary artery spasm (CAS) as assessed by an intracoronary acetylcholine provocation test are limited in series of Asian patients.

AIM:

To investigate 5-year clinical outcomes in patients with CAS according to CAS severity.

METHODS:

In total, 5873 consecutive patients with insignificant coronary artery disease (<70% fixed stenosis) who underwent an acetylcholine provocation test were enrolled and divided into four groups according to CAS severity during the acetylcholine provocation test: negative, borderline positive, moderately positive and severely positive. CAS severity was assessed by quantitative coronary angiography. We investigated 5-year clinical outcomes according to CAS severity.

RESULTS:

Over a follow-up period of up to 5 years, before adjustment, the severely-positive CAS group showed a significantly higher incidence of major adverse cardiac events (MACE; composite of death, myocardial infarction and de novo revascularization) (hazard ratio [HR]: 1.834, 95% confidence interval [CI]: 1.047-3.211; P=0.033), total death (HR: 3.124, 95% CI: 1.047-9.322; P=0.041), myocardial infarction (HR: 3.190, 95% CI: 1.069-9.519; P=0.037) and recurrent angina (HR: 1.762, 95% CI: 1.363-2.278; P<0.001) compared with the negative group. However, after adjustment for baseline confounders, only the incidence of recurrent angina (HR: 1.323, 95% CI: 1.014-1.726; P=0.039) was significantly higher in the severely-positive CAS group compared with the negative group.

CONCLUSIONS:

The severity of CAS in the positive group was not associated with an increased incidence of MACE after adjustment for covariates compared with the negative group, but the severely-positive CAS group was associated with a higher incidence of recurrent angina compared with the negative group.

• Authors: Yong Hoon Kim, Ae-Young Her, Seung-Woon Rha, Byoung Geol Choi, Minsuk Shim, Se Yeon Choi, Jae Kyeong Byun, Hu Li, Woohyeun Kim, Jun Hyuk Kang, Jah Yeon Choi, Eun Jin Park, Sung Hun Park, Sunki Lee, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh
• Journal: Archives of cardiovascular diseases (Arch Cardiovasc Dis) Vol. 111 Issue 3 Pg. 144-154 (Mar 2018) ISSN: 1875-2128 [Electronic] Netherlands
• PMID: 29030064 (Publication Type: Journal Article, Observational Study)
• Copyright: Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Chemical References

• Vasoconstrictor Agents
• Acetylcholine

Topics

• Acetylcholine (administration & dosage)
• Adult
• Aged
• Cause of Death
• Coronary Angiography
• Coronary Stenosis (diagnosis, mortality, physiopathology)
• Coronary Vasospasm (chemically induced, diagnosis, mortality, physiopathology)
• Coronary Vessels (drug effects, physiopathology)
• Female
• Humans
• Incidence
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Myocardial Infarction (mortality, physiopathology)
• Predictive Value of Tests
• Prognosis
• Proportional Hazards Models
• Risk Factors
• Seoul (epidemiology)
• Severity of Illness Index
• Time Factors
• Vasoconstriction (drug effects)
• Vasoconstrictor Agents (administration & dosage)