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Published on: May 8, 2012
Relation between previously implanted coronary stents and vasospasm: Patient- and vessel-level analysis
Kayo Yamamoto1, Yuichi Saito1, Kazuya Tateishi1
1Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
Insights
Previously implanted coronary stents increase the risk of vasospasm during acetylcholine (ACh) testing. This study found higher rates of positive ACh tests and vessel-level vasospasm in patients with stents, indicating altered coronary reactivity.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Physiology
Background:
- Coronary artery stenting can cause arterial injury, leading to endothelial dysfunction and vasospasm.
- The effect of prior coronary stents on vasospasm during acetylcholine (ACh) testing is not well understood.
Purpose of the Study:
- To investigate the impact of previously implanted coronary stents on vasospasm during intracoronary ACh provocation testing.
- To compare vasospasm rates at both patient and vessel levels in patients with and without prior coronary stents.
Main Methods:
- A total of 1039 patients undergoing ACh provocation tests were analyzed.
- Patients were categorized based on the presence or absence of previously implanted coronary stents.
- Coronary vasospasm was assessed angiographically and correlated with symptoms and ECG changes.
Main Results:
- Patients with prior stents showed a significantly higher incidence of positive ACh tests (60.6% vs. 52.0%).
- Vessels with stents exhibited more frequent ACh-induced vasospasm (50.0% vs. 33.3%) compared to non-stented vessels.
- No significant difference in vasospasm rates was observed between bare metal and drug-eluting stents.
Conclusions:
- Previously implanted coronary stents are associated with increased coronary vasoreactivity during ACh provocation testing.
- Stents influence vasospasm at both the patient and vessel levels, highlighting their role in altered coronary function.
Background:
Catheter-based coronary interventions, particularly those with stent implantation, are associated with arterial wall injury, leading to endothelial dysfunction and vasospasm. However, the impact of previously implanted coronary stents on vasospasm during acetylcholine (ACh) provocation testing remains uncertain.
Methods:
From May 2012 to October 2023, a total of 1039 patients underwent intracoronary ACh provocation tests for the diagnosis of vasospastic angina. Patients and coronary vessels were divided into two groups according to the presence of previously implanted coronary stents. Angiographic coronary vasospasm was defined as total or subtotal occlusion induced by ACh injection at the vessel level, and positive diagnosis of ACh testing was defined as angiographic coronary vasospasm accompanied by chest symptoms and/or ischemic electrocardiographic changes at the patient level.
Results:
Of the 1039 patients, 175 (16.8 %) had previously implanted coronary stents. The incidence of positive ACh provocation test was significantly higher in patients with previous coronary stents than in those without (60.6 % vs. 52.0 %, P = 0.04). At the vessel-level analysis, intracoronary ACh was administered in the 175 patients with a history of coronary stenting, with coronary arteries with previously implanted coronary stents (n = 236) and no stents (n = 254). ACh-induced angiographic vasospasm was more frequently observed in vessels with coronary stents than in those without (50.0 % vs. 33.3 %, P < 0.001). No significant interactions between bare metal and drug-eluting stents were found in the rate of ACh-induced vasospasm.
Conclusions:
Previously implanted stents were associated with coronary vasoreactivity during intracoronary ACh provocation testing at the patient and vessel levels.
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