Abstract 2013: Long Term Clinical Prognosis of Provocation Positive Variant Angina
Background Although coronary vasospasm provocation test is widely performed in daily clinical practice, data regarding the long term prognosis of variant angina is still limited.
Methods We retrospectively investigated clinical consequence of 1,736 patients who underwent elective diagnostic coronary angiography and vasospasm provocation test for the evaluation of chest pain from Sep 1994 to Dec 2006. Variant angina was defined by decrease of anterograde coronary flow less than TIMI 2, or new development of severe coronary stenosis (diameter stenosis > 90%) accompanied by typical angina pain and corresponding EKG change provoked by ergonovine intracoronary infusion, followed by nitroglycerin infusion and resolution of vasospasm. Patients who developed spontaneous spasm without provocation or underwent revascularization were excluded.
Results Provocation test was positive in 723 patients and negative in 1,013 patients. Median follow-up period was 1452 days (interquartile range: 711 − 2606), which was not different between two groups. 5-year all major adverse cardiac event (MACE)-free, death-free, and revascularization-free survival was significantly lower in positive provocation group compared to negative group (90.0% versus 95.4%, 92.9% versus 95.7%, 96.8% versus 99.6%, p<0.05 by log-rank test), and cardiac death-free survival was marginally lower in positive provocation group (96.9% versus 98.7%, p=0.051). Although positive provocation group showed higher incidence of smoking, diabetes, hypertension, and significantly fixed stenosis in major coronary arteries (frequency: 19.4% versus 8.2%), multivariate analysis using Cox proportional hazard model revealed that positive provocation test is still an independent predictor of MACE (p<0.001).
Conclusion Our result shows that positive provocation test might be associated with adverse outcome in chest pain patients. It suggests that long term medical care should be provided for patients with positive provocation test.