Abstract 3706: Total Spasm is a New Prognostic Factor on Cardiovascular Events in Patients With Vasospastic Angina
Background: It has been reported that the morbidity rate of vasospastic angina is higher in Japan compared to western countries, and its prognosis has already been reported. However, the prognosis of vasospastic angina in relation to coronary angiographic findings, prognostic risk factors and treatment has not yet been fully investigated.
Methods: From January 2000 to October 2005, 1,047 patients with vasospastic angina diagnosed by coronary angiography performed a coronary spasm induction test by intracoronary infusion of ergonovine at 7 institutions were registered in our cohort study (follow up rate: 91.4%, median follow up duration: 3.8 years). The cardiovascular events were defined as the death from myocardial infarction, cerebral infarction, or heart failure and non-fatal myocardial infarction. Coronary artery spasm was classified into 3 types: total coronary spasm (total spasm: 100 % reduction of the responsible coronary vascular diameter on coronary angiography after infusion of ergonovine in comparison to that after infusion of nitroglycerin); diffuse coronary spasm (diffuse spasm: 75% or more diffuse contraction); and segmental coronary spasm (segmental spasm: 75% or more local contraction).
Results: Cardiovascular events occurred in 34 patients (8.8/1,000 persons/year). The presence of significant coronary artery stenosis (p<0.05, hazard ratio 2.62, 95%CI: 1.09–6.27), diabetes mellitus (p<0.05, hazard ratio 2.90, 95%CI: 1.28–6.58), total spasm (p<0.05, hazard ratio 2.55, 95%CI:1.04–6.26), and age of more than 65 years (p<0.05, hazard ratio 2.74, 95%CI: 1.12–6.67) had a negative prognostic impact on cardiovascular events. Patients were treated with calcium channel blockers such as diltiazem, amlodipine, nifedipine, and benidipine. Among these calcium channel blockers, when patient background was matched by the propensity score in patients treated with calcium channel blockers only, the cardiovascular event rate was significantly lower in the benidipine group than in the diltiazem group (p<0.05, log-rank test).
Conclusions: We demonstrated for the first time that total spasm is a risk factor, independent of other factors, for cardiovascular events in patients with vasospastic angina.