Seung Hwan Han1, Kwan Yong Lee2, Sung Ho Her3, Youngkeun Ahn4, Keun-Ho Park4, Dong-Soo Kim5, Tae-Hyun Yang5, Dong-Ju Choi6, Jung-Won Suh6, Hyuck Moon Kwon7, Byoung Kwon Lee7, Hyeon-Cheol Gwon8, Seung-Woon Rha9, Sang-Ho Jo10, Kwang-Pil Ko11, Sang Hong Baek12. 1. Department of Cardiovascular Medicine, Gil Medical Center, Gachon University, Incheon, South Korea. Electronic address: shhan@gilhospital.com. 2. Department of Cardiovascular Medicine, Incheon St. Mary's Hospital, The Catholic University of Korea, Incheon, South Korea. 3. Department of Cardiovascular Medicine, Daejeon St. Mary's Hospital, The Catholic University of Korea, Daejeon, South Korea. 4. Department of Cardiovascular Medicine, Chonnam National University Hospital, Chonnam National University, Gwangju, South Korea. 5. Department of Cardiovascular Medicine, Busan Paik Hospital, Inje University, Busan, South Korea. 6. Department of Cardiovascular Medicine, Bundang Hospital, Seoul National University, Seongnam, South Korea. 7. Department of Cardiovascular Medicine, Gangnam Severance Hospital, Yonsei University, Seoul, South Korea. 8. Department of Cardiovascular Medicine, Samsung Medical Center, Sungkyunkwan University, Seoul, South Korea. 9. Department of Cardiovascular Medicine, Guro Hospital, Korea University, Seoul, South Korea. 10. Department of Cardiovascular Medicine, Pyeongchon Sacred Heart Hospital, Hallym University, Anyang, South Korea. 11. Department of Preventive Medicine, Gachon University College of Medicine, Incheon, South Korea. 12. Department of Cardiovascular Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea. Electronic address: whitesh@catholic.ac.kr.
Abstract
BACKGROUND AND AIMS: Since clinical characteristics and prognosis of patients with multi-vessel vasospastic angina (VSA) are not clear, we investigated the nature and prognosis of multi-vessel VSA in Koreans. METHODS: Among 2960 patients enrolled in the VA-KOREA (Vasospastic Angina in Korea) registry, 104 definite multi-vessel VSA patients, 163 single vessel VSA patients and 737 non-VSA patients were identified using the intracoronary ergonovine provocation test. RESULTS: Multi-vessel VSA and single vessel VSA groups showed similar baseline characteristics and medical treatment on discharge, but different from the non-VSA group. The primary composite endpoint (cardiac death, acute coronary syndrome, and symptomatic new onset arrhythmia) over a 36-month follow-up period was significantly higher in the multi-vessel VSA group than in the single vessel VSA and non-VSA groups (8.7% vs. 1.8% and 1.1%, each log-rank p < 0.05, respectively). The rate of death and acute coronary syndrome of the multi-vessel VSA group was higher than in the single vessel VSA and non-VSA groups (5.8% vs. 1.2% and 0.9%, each log-rank p < 0.05, respectively). In addition, multi-vessel VSA was an independent predictor of the primary composite endpoint at 36 months (HR 8.5, 95% CI [2.6-27.2], p < 0.0001). CONCLUSIONS: Patients with multi-vessel VSA had worse clinical outcomes than single vessel VSA and non-VSA groups, suggesting that the existence of multi-vessel VSA itself is highly prognostic.
BACKGROUND AND AIMS: Since clinical characteristics and prognosis of patients with multi-vessel vasospastic angina (VSA) are not clear, we investigated the nature and prognosis of multi-vessel VSA in Koreans. METHODS: Among 2960 patients enrolled in the VA-KOREA (Vasospastic Angina in Korea) registry, 104 definite multi-vessel VSA patients, 163 single vessel VSA patients and 737 non-VSA patients were identified using the intracoronary ergonovine provocation test. RESULTS: Multi-vessel VSA and single vessel VSA groups showed similar baseline characteristics and medical treatment on discharge, but different from the non-VSA group. The primary composite endpoint (cardiac death, acute coronary syndrome, and symptomatic new onset arrhythmia) over a 36-month follow-up period was significantly higher in the multi-vessel VSA group than in the single vessel VSA and non-VSA groups (8.7% vs. 1.8% and 1.1%, each log-rank p < 0.05, respectively). The rate of death and acute coronary syndrome of the multi-vessel VSA group was higher than in the single vessel VSA and non-VSA groups (5.8% vs. 1.2% and 0.9%, each log-rank p < 0.05, respectively). In addition, multi-vessel VSA was an independent predictor of the primary composite endpoint at 36 months (HR 8.5, 95% CI [2.6-27.2], p < 0.0001). CONCLUSIONS:Patients with multi-vessel VSA had worse clinical outcomes than single vessel VSA and non-VSA groups, suggesting that the existence of multi-vessel VSA itself is highly prognostic.