3-Year Follow-Up of Patients With Coronary Artery Spasm as Cause of Acute Coronary Syndrome

Ong, Peter; Athanasiadis, Anastasios; Borgulya, Gábor; Voehringer, Matthias; Sechtem, Udo

doi:10.1016/j.jacc.2010.08.626

Cited by 146 publications

(42 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, prolonged spasm is commonly associated with other emergency conditions, including acute coronary syndrome and life-threatening arrhythmias [16,17]. Thus, early accurate diagnosis and further VSA management is important.…”

Section: Discussionmentioning

confidence: 99%

Assessing Vessel Tone during Coronary Artery Spasm by Dual-Acquisition Multidetector Computed Tomography Angiography

Jin

Kim²,

Kang

et al. 2017

Cardiology

View full text Add to dashboard Cite

Background: Diminished vascular tone is an established biomarker of heart damage. Little is known about the extent of coronary vessel tone (CVT) with spasm as assessed by dual-acquisition multidetector computed tomography angiography (MCTA) in patients with vasospastic angina (VSA). Objective: We evaluated the CVT modulated by intravenous nitrate injection (INI) using MCTA imaging in VSA patients. Methods: Twenty-one VSA patients (60 ± 9 years; 76% males) who underwent initial MCTA (without morning vasodilation), followed by an intracoronary ergonovine provocation test were included. Within 3 days after the initial MCTA patients received INI followed by 28-vessel segment spasm analyzed by MCTA 3D software, applying the following formula as the definition of CVT index (CVTI): (CSA_{IV nitrate} - CSA_initial/CSA_{IV nitrate}) ×100 %, where CSA is the cross-sectional area. Results: Compared to the initial MCTA measures, the INI provocation resulted in the significant increase of average diameter and CSA at the spasm site (2.60 mm [2.11-3.16] vs. 1.42 mm [1.13-2.13]; 5.37 mm² [3.67-7.54] vs. 1.62 mm² [1.02-3.02]; p < 0.001). The CVTI at the spastic segments was higher than at the proximal reference segments (41.0% [21.8-52.3] vs. 18.8% [5.9-26.6] for CVTI diameter; 65.1% [38.6-77.0] vs. 33.9% [5.2-48.1] for CVTI CSA, respectively). To predict VSA, the cut-off value for CVTI diameter was 38.6% (AUC 0.777; 95% CI 0.653-0.901) and 62.5% (AUC 0.779; 95% CI 0.657-0.902) for CVTI CSA in a receiver-operating characteristic curve analysis, with 57.1% sensitivity and 92.9% specificity. Conclusions: This novel imaging technique for assessing CVT by dual-acquisition MCTA after applying INI provocation is suitable for the detection of coronary artery spasm in patients with VSA.

show abstract

Section: Discussionmentioning

confidence: 99%

Assessing Vessel Tone during Coronary Artery Spasm by Dual-Acquisition Multidetector Computed Tomography Angiography

Jin

Kim²,

Kang

et al. 2017

Cardiology

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

“…ACS patients with coronary spasm and nonobstructive coronary artery disease have a favorable prognosis for survival and coronary events 11, 12. In the Coronary Artery Spasm in Patients with Acute Coronary Syndrome study, nonobstructive ACS patients with documented coronary spasm showed no cardiac death or nonfatal MI during a 3‐year follow‐up 11. In a Japanese population, cardiovascular events occurred in 15 (4.7%) patients with coronary artery spasm, including 1 (0.3%) patient with cardiovascular death and 4 (1.3%) patients with MI during a mean follow‐up duration of 20 months 12.…”

Section: Discussionmentioning

confidence: 99%

“…These findings could possibly be explained by the fact that urgent presentation with documented myocardial ischemia reflects severe stenosis or occlusion of the coronary artery by vasospasm. In these patients, disturbances of the coronary microcirculation result in decreased coronary reserve or microvascular spasm that causes repetitive angina during exercise or at rest 11. In addition, the increased risks of MACE and recurrent MI were consistently observed in VAMI patients.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Outcomes of Vasospastic Angina Patients Presenting With Acute Coronary Syndrome

Cho

Park

Gwag

et al. 2016

JAHA

View full text Add to dashboard Cite

BackgroundCoronary vasospasm is an important pathogenesis of acute coronary syndrome (ACS). However, the clinical features and prognosis of vasospastic angina (VA) patients presenting with ACS (VAACS) are still unclear. We aimed to evaluate the clinical characteristics and long‐term outcomes of VAACS patients without significant coronary artery stenosis.Methods and ResultsA total of 986 VA patients confirmed by ergonovine provocation test were analyzed. VAACS was defined as VA patients visiting the emergency room with documented electrocardiographic changes, significant arrhythmias, or elevated cardiac biomarkers. VA patients with elevated cardiac biomarkers were further considered to have myocardial infarction (MI; VAMI). During 4.4 years of median follow‐up, we investigated major adverse cardiac events including cardiac death, MI, revascularization, and rehospitalization because of recurrent angina. The VAACS group consisted of 149 patients (15.1%), and VAMI occurred in 81 patients (8.2%). VAACS patients were younger and had a higher prevalence of diabetes mellitus, MI history, and higher levels of inflammatory markers compared with non‐VAACS patients. In multivariable Cox regression analyses, VAACS patients were associated with an increased risk of major adverse cardiac events (hazard ratio, 1.65; 95% CI 1.14–2.37; P=0.007) and recurrent MI hazard ratio, 2.57; 95% CI, 1.35–4.87; P=0.004). In addition, VAMI patients had an increased risk of major adverse cardiac events (hazard ratio, 1.75; 95% CI, 1.11–2.76; P=0.016) and recurrent MI (hazard ratio, 2.43; 95% CI, 1.09–5.40; P=0.03).Conclusion VAACS patients showed worse clinical outcomes, driven mainly by recurrent MI. Therefore, intensive medical treatment might be required in VAACS patients.

show abstract

“…After 3 years of the CASPAR study follow-up, ACS patients without culprit lesions were seen to have an excellent prognosis for survival and coronary events compared with patients with obstructive ACS. However, persistent angina represents a challenging problem in these patients, leading to repeated coronary angiography in some cases [5]. Data on prognosis in ACS patients without culprit lesions in China are sparse.…”

Section: Introductionmentioning

confidence: 99%

Three-year follow-up in patients with acute coronary syndrome and normal coronary angiography

Sun

Zhang

Zeng

et al. 2012

Coronary Artery Disease

View full text Add to dashboard Cite

show abstract

3-Year Follow-Up of Patients With Coronary Artery Spasm as Cause of Acute Coronary Syndrome

Cited by 146 publications

References 22 publications

Assessing Vessel Tone during Coronary Artery Spasm by Dual-Acquisition Multidetector Computed Tomography Angiography

Assessing Vessel Tone during Coronary Artery Spasm by Dual-Acquisition Multidetector Computed Tomography Angiography

Clinical Outcomes of Vasospastic Angina Patients Presenting With Acute Coronary Syndrome

Three-year follow-up in patients with acute coronary syndrome and normal coronary angiography

Contact Info

Product

Resources

About