Abstract 13374: Variant Angina Is Associated with a Higher Incidence of MACE in Patients with Vasospastic Angina-A Report from the Nationwide Multi-Center Registry by the Japanese Coronary Spasm Association-
Background: Coronary vasospasm plays an important role in the pathogenesis of a wide variety of ischemic heart diseases. In patients with vasospastic angina (VSA), variant angina (VA) is characterized by spontaneous attacks at rest with ST elevation. Clinical features and outcomes of VA patients were studied in the nationwide multi-center registry study by the Japanese Coronary Spasm Association.
Methods: Between September 2007 and December 2008, a total of 1,521 VSA patients (M/F, 1163/358; age, 65±11 [SD] years), including 287 VA patients (19%), were registered from 47 institutes with a mean follow-up period of 36±23 months. VSA was diagnosed on the basis of the Japanese Circulation Society Guideline 2008. The primary outcome included major adverse cardiac events (MACE), such as cardiac death, non-fatal myocardial infarction, hospitalization due to heart failure and unstable angina.
Results: Typical circadian pattern of VA was identified mostly from midnight to early morning; 0 am to 4 am (n=52), 4 am to 8 am (n=89), 8 am to noon (n=41), noon to 4 pm (n=13), 4 pm to 8 pm (n=15) and 8 pm to 12 pm (n=16). In comparison with non-VA patients, VA patients were characterized by younger (VA 64±10 vs. non-VA 66±11 years, P=0.01), higher incidence of male (VA 86 vs. non-VA 74 %, P<0.001), smoking (VA 68 vs. non-VA 57%, P<0.001), previous myocardial infarction (VA 9 vs. non-VA 6%, P=0.042) and brady-arrhythmia during attacks (VA 12 vs. non-VA 2%, P<0.001). Although the use of Ca channel blockers (VA 97 vs. non-VA 95%, P=0.005) and that of nitrates were higher (VA 57 vs. non-VA 48%, P=0.002), 5-year MACE-free survival rate was significantly lower in VA patients compared to non-VA patients (VA 89 vs. non-VA 92%, P=0.015). In multivariate Cox proportional hazard regression analysis performed after adjustment for potential confounders such as age, gender, smoking, multivessel spasm and organic coronary stenosis, VA still remained a significant prognostic factor for 5-year MACE (adjusted hazard ratio, 1.81; 95% confidence interval, 1.13 to 2.91; P=0.014).
Conclusions: These results indicate that among VSA patients, those with VA are at higher risk of MACE than those without it, suggesting that more intensive medical therapy and close follow-up are needed for VA patients.
- © 2010 by American Heart Association, Inc.