Abstract 15194: Arrhythmic Complications of Coronary Spasm Provocation Tests and Its Prognostic Impact in Patients with Vasospastic Angina -A Report from the Nationwide Multi-Center Registry by the Japanese Coronary Spasm Association-
Background: Coronary vasospasm provocation tests are useful for the diagnosis of vasospastic angina (VSA). However, these tests have a potential risk of arrhythmic complications including ventricular tachycardia (VT), ventricular fibrillation (VF) and brady-arrhythmias caused by myocardial ischemia due to the spasm.
Methods: We enrolled a total of 1,521 patients (M/F, 1163/358; age, 65±11 [SD] years), including 1,328 patients (87%) who underwent the provocation tests, between September 2007 and December 2008 from 47 institutes and they were followed up with a mean period of 36 months. We evaluated the incidence of arrhythmic complications during provocation tests and the clinical outcomes of patients with provocation-related VT/VF.
Results: During the provocation tests, VT/VF, AV block and cardiac arrest developed at a rate of 3.1, 0.6 and 0.2%, respectively. Overall incidence of arrhythmic complications was 6.7%, a comparable incidence of those during spontaneous attacks (7.0%) (Table). The provocation tests were performed with either acetylcholine (ACh, 59%), ergonovine (Erg, 39%), or both (1.7%). Since the ACh group (n=58) included more number of patients with documented VF/VF during spontaneous attacks than the Erg group (n=15) (ACh 7.4% vs. Erg 2.9%, P<0.05), the incidence of VT/VF during the provocation test was proportionally higher in the former (ACh 4.6% vs. Erg 0.8%, P<0.001). Multivariate analysis following adjustment for potential confounders, such as age, gender, smoking, multi-vessel spasm and organic coronary stenosis, demonstrated that VT/VF during spontaneous attack was a significant predictor of major adverse cardiac events (hazard ratio, 2.80; 95% CI, 1.31 to 5.95; P=0.008) but VF/VF during provocation test was not.
Conclusions: These results indicate that the provocation test for coronary vasospasm is relatively safe with a low incidence of arrhythmic complication and is unlikely to affect the prognosis of VSA patients.
- © 2010 by American Heart Association, Inc.