Abstract 4567: Prognostic Significance of Life-Threatening Arrhythmias During Spontaneous Attack of Vasospastic Angina -Multicenter Registry Study of the Japanese Coronary Spasm Association
Background: Coronary vasospasm plays an important role in the pathogenesis of a wide variety of ischemic heart diseases. Recent progress of the second-generation calcium channel blockers (CCBs) or life-style change such as decreasing smoking habits may affect the prognosis of patients with vasospstic angina (VSA). Thus, we conducted the nationwide multicenter registry by the Japanese Coronary Spasm Association to elucidate the clinical outcomes of patients with VSA in the current era.
Methods: Between September 2007 and December 2008, a total of 1,521 patients (M/F, 1163/358: age, 65±11 [SD] years) were retrospectively registered from 44 institutes with a mean follow-up period of 36±23 months. VSA was diagnosed on the basis of the Japanese Circulation Society Guideline 2008, including
spontaneous anginal attack accompanied by ischemic ECG changes and no significant organic stenosis by coronary angiography and/or
the development of >90% coronary vasoconstriction accompanied by chest pain and/or ischemic ECG changes by provocation test.
The primary outcome included all cause death and major adverse cardiac events (MACE), such as cardiac death, non-fatal myocardial infarction, hospitalization due to heart failure and unstable angina.
Results: Approximately 60% of the patients had a smoking history and more than 90% of them were treated with CCBs. Five-year survival rate free from all cause death or MACE was 98% and 92%, respectively. Multivariate analysis using Cox proportional hazard model revealed that smoking habits (hazard ratio, 1.75; 95% confidence interval [CI], 1.07 to 2.85; P=0.025), organic coronary stenosis >50% in major coronary arteries (hazard ratio, 1.96; 95% CI, 1.27 to 3.02; P=0.002), life-threatening arrhythmias during spontaneous attack (hazard ratio, 2.87; 95% CI, 1.38 to 5.98; P=0.005) and discontinuation or reduction of medications (hazard ratio, 8.66; 95% CI, 4.59 to 16.37; P<0.001) were independent predictor of MACE.
Conclusions: Event-free survival in patients with VSA is fairly well with medical treatment. In addition to the known factors (e.g. smoking and organic coronary stenosis), life-threatening arrhythmias during spontaneous attack has a significant prognostic impact in VSA.