Abstract 12750: Clinical Features and Long-term Prognosis in Patients with Coronary Spasm-induced non-ST-segment Elevation Acute Coronary Syndrome
Although coronary spasm plays an important role in the pathogenesis of ischemic heart disease, its impact on non-ST-segment elevation acute coronary syndrome (NSTE-ACS) has not been fully elucidated. We evaluated the prevalence, clinical features, and long-term outcome of patients with NSTE-ACS caused by coronary spasm in Japanese population. The consecutive 1,601 patients who hospitalized with the diagnosis of NSTE-ACS and underwent cardiac catheterization were studied. Culprit lesion was found in 1,152 (72%) patients. In patients without culprit lesion, coronary spasm was verified in 145 patients with spontaneous attack, and verified in 175 out of 221 patients who underwent acetylcholine-provocation test. Spasm-induced NSTE-ACS was diagnosed in 320 (20%) patients. Multivariate analysis identified that age ≤70 years (odds ratio [OR] 2.19), hypertension (OR 0.39), dyslipidemia (OR 0.36), diabetes mellitus (OR 0.40), previous myocardial infarction (OR 0.19), estimated glomerular filtration rate >60 ml/min/1.73 m2 (OR 1.72), and elevated cardiac biomarkers (OR 0.35) as significant predictors of spasm-induced NSTE-ACS (p≤0.01 in all predictors). Transient ST-segment elevation during spontaneous attack (variant angina) before or after hospitalization was observed in 119 patients with spasm-induced NSTE-ACS. Younger age, male sex, current smoking, and dyslipidemia were significantly associated with the presence of variant angina in spasm-induced NSTE-ACS. During 20 ± 8 months of follow-up, cardiovascular death and readmission due to myocardial infarction, unstable angina, stroke, and heart failure were less frequently observed in patients with spasm-induced NSTE-ACS than in those with culprit lesion (5% vs 14%, p≤0.01). In patients with spasm-induced NSTE-ACS, variant angina did not affect the clinical outcome (5.9% vs 4.0%, p=0.40, in patients with and without variant angina, respectively). In conclusion, the frequent involvement of coronary spasm in the pathogenesis of NSTE-ACS was shown in Japanese patients. Variant angina was observed in one third of patients with spasm-induced NSTE-ACS. Coronary spasm should be considered even in patients with less coronary risk factors and non-obstructive coronary arteries.
- © 2013 by American Heart Association, Inc.