Affiliation:
1. Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
2. Department of General Medicine, Yamaguchi University Hospital, Ube, Japan
Abstract
Background
The aim of this study was to elucidate the correlation between angiographic coronary vasomotor responses to intracoronary acetylcholine (
AC
h) injection, clinical features, and long‐term prognosis in patients with vasospastic angina (
VSA
).
Methods and Results
This is a retrospective, observational, single‐center study of 1877 consecutive patients who underwent
AC
h‐provocation test between January 1991 and December 2010.
AC
h‐provoked coronary spasm was observed in 873 of 1637 patients included in the present analysis.
AC
h‐positive patients were more likely to be older male smokers with dyslipidemia, to have a family history of ischemic heart disease, and to have a comorbidity of coronary epicardial stenosis than were
AC
h‐negative patients.
AC
h‐positive patients were divided into 2 groups: those with focal (total or subtotal obstruction, n=511) and those with diffuse (severe diffuse vasoconstriction, n=362) spasm patterns. Multivariable logistic regression analysis identified female sex and low comorbidity of coronary epicardial stenosis to correlate with the
AC
h‐provoked diffuse spasm pattern in patients with
VSA
.
K
aplan–
M
eier survival curve indicated better 5‐year survival rates free from major adverse cardiovascular events in patients with diffuse spasm pattern compared with those with focal spasm pattern (
P
=0.019). Multivariable Cox hazard regression analysis identified diffuse spasm pattern as a negative predictor of major adverse cardiovascular events in patients with
VSA
.
Conclusions
AC
h‐induced diffuse coronary spasm was frequently observed in female
VSA
patients free of severe coronary epicardial stenosis and was associated with better prognosis than focal spasm. These results suggest the need to identify the
AC
h‐provoked coronary spasm subtypes in patients with
VSA
.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
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