Abstract 20989: Coronary Artery Spasm and Prognosis in Patients on Optimal Chronic Antispasmodic Therapy

Abstract

Objectives: To investigate the impact of ergonovine (E)-induced coronary spasm during coronary angiography on long-term prognosis in patients with chest pain and non-significant coronary artery stenosis.

Methods: All consecutive patients with non-significant coronary stenosis undergoing an E provocation test because of clinical suspicion of variant angina were recruited. For all patients, vasoactive medications were withheld for at least 48 hours before catheterization. Intravenous E was administered at the end of the diagnostic catheterization and vasoreactivity and coronary artery spasm were assessed angiographically. By protocol, intracoronary nitrates were administered after E in all cases. End-points of the study were: a) long-term survival rates (10 years) and b) long-term survival free of cardiovascular events (stroke, myocardial infarction, revascularization) respectively, c) hospitalizations and d) presence of angina. All patients were on optimal antispasmodic therapy during the study follow-up.

Results: In total, 218 patients (mean age: 56±11 years) were enrolled. All patients were on optimal medical treatment. The mean duration of follow-up was: 75±51 months. The E test was characterized as positive in 79 patients (43% women). Long-term survival rates were lower in patients with positive E test (84% vs 96%, p=0.04) (figure). Similarly, long-term survival free of cardiovascular events was also lower in the same group (71% vs 91%, p=0.004). Hospitalizations and presence of angina were comparable between patients with positive E test (6% and 27%) and patients with negative E test (8% and 28%).

Conclusions: Coronary artery spasm induced during ergonovine provocation test, associates with worse long-term clinical outcome among patients with chest pain and non-significant coronary artery stenosis.