Dae-Won Kim1, Sung-Ho Her2, Youngkeun Ahn3, Dong Il Shin4, Seung Hwan Han5, Dong-Soo Kim6, Dong-Ju Choi7, Hyuck Moon Kwon8, Hyeon-Cheol Gwon9, Sang-Ho Jo10, Seung-Woon Rha11, Sang Hong Baek12. 1. Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Dae-Jeon, South Korea. 2. Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Dae-Jeon, South Korea. Electronic address: hhhsungho@naver.com. 3. Cardiovascular Center, Chonnam National University Hospital, Chonnam National University, Gwangju, South Korea. 4. Cardiovascular Center, Sungmo Hospital, Pyeongtaek, South Korea. 5. Gil Medical Center, Gachon University, Incheon, South Korea. 6. Busan Paik Hospital, Inje University, Busan, South Korea. 7. Bundang Hospital, Seoul National University, Seongnam, South Korea. 8. Gangnam Severance Hospital, Yonsei University, Seoul, South Korea. 9. Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea. 10. Pyeongchon Sacred Heart Hospital, Hallym University, Anyang, South Korea. 11. Guro Hospital, Korea University, Seoul, South Korea. 12. Division of Cardiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
Abstract
BACKGROUND: This study aimed to evaluate clinical implications of single vessel coronary spasm provoked by intracoronary ergonovine provocation test in Korean population. METHOD: A total of 1248 patients who presented with single vessel coronary artery spasm induced by intracoronary ergonovine provocation test, excluding 1712 with negative spasms, multiple and mixed coronary artery spasms and missing data among 2960 patients in the VA-KOREA (Vasospastic Angina in Korea) registry, were classified into diffuse (n=705) and focal (n=543) groups. RESULTS: The 24-month incidences of a composite primary endpoints (cardiac death, new-onset arrhythmia, and acute coronary syndrome) were determined. Over a median follow-up of 30months, the composite primary end point occurred more frequently in the focal type patients than in the diffuse type patients (primary endpoint: adjusted hazard ratio [aHR], 1.658; 95% confidence interval [CI] 1.272 to 2.162, P<0.001). Especially, unstable angina in ACS components played a major role in this effect (hazard ratio [HR], 2.365; 95% confidence interval [CI] 1.100 to 5.087, P=0.028). CONCLUSION: Focal type of single vessel coronary artery spasm in vasospastic angina (VSA) patients is found to be associated with worse clinical outcomes. It is thought that the effect is stemmed from unstable angina among ACS rather than the other components of primary endpoint. Therefore, focal type of single vessel coronary artery spasm in patients with VSA should be more carefully assessed and managed with appropriate medication.
BACKGROUND: This study aimed to evaluate clinical implications of single vessel coronary spasm provoked by intracoronary ergonovine provocation test in Korean population. METHOD: A total of 1248 patients who presented with single vessel coronary artery spasm induced by intracoronary ergonovine provocation test, excluding 1712 with negative spasms, multiple and mixed coronary artery spasms and missing data among 2960 patients in the VA-KOREA (Vasospastic Angina in Korea) registry, were classified into diffuse (n=705) and focal (n=543) groups. RESULTS: The 24-month incidences of a composite primary endpoints (cardiac death, new-onset arrhythmia, and acute coronary syndrome) were determined. Over a median follow-up of 30months, the composite primary end point occurred more frequently in the focal type patients than in the diffuse type patients (primary endpoint: adjusted hazard ratio [aHR], 1.658; 95% confidence interval [CI] 1.272 to 2.162, P<0.001). Especially, unstable angina in ACS components played a major role in this effect (hazard ratio [HR], 2.365; 95% confidence interval [CI] 1.100 to 5.087, P=0.028). CONCLUSION: Focal type of single vessel coronary artery spasm in vasospastic angina (VSA) patients is found to be associated with worse clinical outcomes. It is thought that the effect is stemmed from unstable angina among ACS rather than the other components of primary endpoint. Therefore, focal type of single vessel coronary artery spasm in patients with VSA should be more carefully assessed and managed with appropriate medication.
Authors: Vincent Ngo; Anahita Tavoosi; Alexandre Natalis; Francois Harel; E Marc Jolicoeur; Robert S B Beanlands; Matthieu Pelletier-Galarneau Journal: J Nucl Cardiol Date: 2022-03-23 Impact factor: 5.952