Abstract 4233: Additive Prognostic Implication of Ergonovine Echocardiography Performed after Coronary Angiographic Confirmation of Insignificant Fixed Stenosis
Background: The clinical significance of coronary vasospasm (CVS) in patients without significant coronary artery stenosis is not certain in this era of interventional cardiology. Moreover, role of spasm provocation testing using ergonovine and 2-dimensional echocardiography (Erg Echo) and its prognostic implication have not been tested in a long-term outcome study.
Methods: We evaluated clinical data of consecutive patients who underwent both Erg Echo and coronary angiography (CAG) between Jan 1996 to Dec 2006. Before Erg Echo, absence of significant coronary artery stenosis was confirmed by CAG. Clinical events included cardiac death, myocardial infarction, follow-up revascularization, readmission due to intractable chest pain during follow up. The national vital statistics death file obtained through Dec 2006 was used for follow-up data.
Results: A total of 564 patients (age 55 ± 10 years) were enrolled and Erg Echo was positive in 148 patients (26.4%, group 1), who showed higher rate of current smoker compared to those with negative Erg Echo (group 2). The mean follow-up was 4.3 ± 3.7 years. The incidence of cardiac death was not different between groups (3.4% vs 1.4%, p=0.14). During follow-up, revascularization procedure (3.4% vs 1%, p=0.04) and hospital admission due to intractable chest pain (12.8% vs 6.3%, p=0.01) occurred more frequently in group 1. The 10-year clinical event-free rates were 71.9±7.1% and 89.9±2.2%, respectively (p=0.01).
Conclusions: CVS could be documented in considerable numbers of patients with near normal coronary angiogram and significantly lower event-free survival rate in these selected patients supports prognostic impact of Erg Echo.