Abstract 13551: Impact of Acetylcholine-provoked Diffuse Coronary Spasm on Clinical Features and Long-term Prognosis of Patients With Coronary Spasm
Coronary vasospastic angina (VSA) plays an important role in the pathogenesis of ischemic heart disease (IHD). It is reported that patients with VSA have better prognosis than those with obstructive coronary artery disease (CAD). However, the relation between acetylcholine (ACh)-provoked coronary spasm subtypes, clinical features, and long-term prognosis of VSA patients has not been fully investigated. We analyzed the correlation between ACh-provoked coronary spasm subtypes and its contributing factors in VSA patients. We examined 1877 consecutive patients who underwent ACh-provocation test between January 1991 and December 2010. Coronary spasm was observed in 873 out of 1637 patients enrolled in the present analysis. ACh-positive patients were more likely to be older male smokers with dyslipidemia, had family history of IHD, and comorbidity of obstructive CAD than ACh-negative patients. ACh-positive patients were divided into two groups; focal (total or subtotal obstruction, n=511) and diffuse (severe diffuse vasoconstriction, n=362) spasm patterns. Diffuse spasm group were more likely to be female without hypertension and less comorbidity of obstructive CAD than focal spasm group. Multivariable logistic regression analysis identified female gender and low comorbidity of obstructive CAD to correlate with the diffuse spasm pattern (OR: 2.928; 95%CI: 2.116-4.054; p<0.001 and OR: 0.562; 95%CI: 0.380-0.832; p=0.004). During the mean follow-up period of 49±19 months, major adverse cardiac events (MACE) were observed in 43 patients. Kaplan-Meier survival curve indicated better 5-year survival rates free from MACE in patients with diffuse spasm pattern compared to those with focal spasm pattern (p=0.019). Multivariable Cox hazard regression analysis identified focal spasm pattern as predictor of MACE in VSA patients (HR: 2.872; 95% CI: 1.159 to 7.118; p=0.023). In conclusion, ACh-induced diffuse coronary spasm was frequently observed in female VSA patients free of severe obstructive CAD, and was associated with better prognosis than focal spasm. These results emphasize the need to treat patients with ACh-provoked diffuse spasm, similar to that enforced in patients with focal spasm.
- © 2013 by American Heart Association, Inc.