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Five-year clinical outcomes in patients with significant coronary artery spasm: A propensity score-matched analysis
Byoung Geol Choi1, Sang-Ho Park2, Seung-Woon Rha3
1Cardiovascular Center, Korea University Guro Hospital, Seoul, Republic of Korea; Department of Medicine, Korea University Graduate School, Seoul, Republic of Korea.
Insights
Coronary artery spasm (CAS) affects over half of patients and may increase recurrent angina risk. However, CAS did not significantly worsen major clinical outcomes like mortality or heart attack with optimal medical therapy.
Area of Science:
- Cardiology
- Vascular Medicine
- Clinical Outcomes Research
Background:
- Coronary artery spasm (CAS) is a known risk factor for acute coronary syndrome and angina pectoris.
- Limited large-scale, real-world data exists on the long-term clinical outcomes of CAS.
Purpose of the Study:
- To determine the prevalence of CAS in Asian patients.
- To evaluate the 5-year clinical outcomes associated with CAS.
- To assess the impact of CAS using intracoronary acetylcholine (Ach) provocation tests.
Main Methods:
- 1413 patients without significant coronary artery disease (CAD) underwent Ach provocation tests.
- Significant CAS defined as >70% narrowing post-Ach injection.
- Propensity score matching (PSM) used to compare CAS (n=773) and non-CAS (n=640) groups.
Main Results:
- CAS prevalence was 54.7% (773/1413).
- After PSM (451 pairs), the CAS group showed a trend towards higher recurrent angina requiring angiography (HR 1.56, p=0.054).
- No significant differences in mortality, myocardial infarction, or revascularization between groups.
Conclusions:
- CAS is prevalent (54.7%) in this Asian cohort.
- CAS may be associated with increased recurrent angina, but not major adverse cardiovascular events.
- Optimal medical therapy appears to mitigate severe outcomes in CAS patients.
Background:
Coronary artery spasm (CAS) is known to be a risk factor of acute coronary syndrome and angina pectoris. However, there is no currently available data with larger study population regarding long-term clinical outcomes of CAS in real world clinical practice.
Objectives:
We evaluated the prevalence of CAS and the impact of CAS on 5-year clinical outcomes in a series of Asian CAS patients documented by intracoronary acetylcholine (Ach) provocation test.
Methods:
A total of 1413 consecutive patients without significant coronary artery disease (CAD) who underwent Ach provocation test between Nov. 2004 and Oct. 2008 were enrolled. Significant CAS was defined as >70% of narrowing by incremental intracoronary injection of 20, 50 and 100 μg. Patients were divided into two groups based on the presence of significant CAS (the non-CAS group: n=640, the CAS group; n=773). To adjust potential confounders, a propensity score matched (PSM) analysis was performed using the logistic regression model.
Results:
A total of 54.7% (773/1413) patients were diagnosed as CAS documented by Ach provocation test. After PSM analysis, 2 propensity-matched groups (451 pairs, n=902, C-statistic=0.677) were generated. Despite of similar incidence of individual hard endpoints including mortality, myocardial infarction and revascularization, the CAS group showed the higher trend of recurrent angina requiring follow up angiography than the non-CAS group up to 5 years (HR; 1.56, 95% C.I.; 0.99-2.46, p=0.054).
Conclusions:
The prevalence of CAS was 54.7%. Although the cumulative incidence of recurrent angina requiring follow up coronary angiography seems to be increased up to 5 years in CAS patients, CAS patients was not associated with major individual and composite clinical outcomes such as mortality, MI, PCI, CVA with optimal medical therapy as compared with patients without CAS.
