Clinical Characteristics and Prognosis of Patients with Multi-Vessel Coronary Spasm in Comparison with Those in Patients with Single-Vessel Coronary Spasm

Teragawa, Hiroki; Oshita, Chikage; Uchimura, Yuko

doi:10.3390/jcdd9070204

Cited by 8 publications

(16 citation statements)

References 35 publications

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“…Fifth, in some of the patients who underwent repeat SPT in the present study, those who already had coronary spasms in two vessels (LAD and LCX) and a diagnosis of MVS were evaluated to determine whether a coronary spasm would develop in the third coronary artery. However, the difference in prognosis between two-vessel and three-vessel coronary spasms among patients with MVS is not clear [ 13 ], and future studies are required to determine whether patients with two-vessel spasms should be evaluated for three-vessel spasms. Sixth, the methods in the present study include vascular response testing by brachial ultrasonography, which is not common.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Characteristics and Prognosis of Patients with Vasospastic Angina Subjected to the Spasm Provocation Test and the Unavoidable Use of Nitroglycerin

Teragawa

Oshita

Uchimura

2023

JCDD

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Background: Multi-vessel spasm (MVS) has a prognostic impact in patients with vasospastic angina (VSA). Thus, the presence of coronary spasm in both the left coronary artery (LCA) and right coronary artery (RCA) should be assessed through the spasm provocation test (SPT). Nitroglycerin (NTG) is used to avoid SPT-related complications; however, this unavoidable use of NTG may decrease the detection of MVS. Therefore, we investigated the frequency of the unavoidable use of NTG during SPT and clarified the clinical characteristics in patients with VSA who underwent the unavoidable use of NTG during STP. Methods: A total of 141 patients with positive SPT were evaluated. A positive SPT was defined as > 90% constriction in epicardial coronary arteries in response to acetylcholine, accompanied by the usual chest symptoms and/or ischaemic ST-T changes on electrocardiography. When a coronary spasm occurred, we usually wait for the spontaneous relief of the coronary spasm. However, if a prolonged coronary spasm or unstable haemodynamics occurred, 0.3 mg NTG was administered intracoronarily to promptly relieve the coronary spasm and this was defined as the unavoidable use of NTG. Even when the unavoidable use of NTG was administered in one coronary artery, an additional SPT was performed on another coronary artery. If a coronary spasm occurred in another coronary artery, a positive SPT was diagnosed. In contrast, if a coronary spasm was not induced after the unavoidable use of NTG, the judgement was classified as undiagnosed. The patients were divided into two groups according to the unavoidable use of NTG: U-NTG (n = 42) and the final use of NTG: F-NTG (n = 99). The clinical characteristics and frequencies of MVS (≥2 major coronary arteries in which a coronary spasm was provoked) and complications (malignant arrhythmia and unstable haemodynamics requiring catecholamines) during the SPT were compared between the groups. Results: Except for smoking status, all other clinical characteristics did not differ significantly between the groups. More current smokers were observed in the U-NTG group (29%) than in the F-NTG group (12%, p = 0.02). The frequency of MVS did not vary significantly between the groups (p = 0.28), with 64% for U-NTG and 55% for F-NTG. No significant difference was found between the groups in the frequency of severe complications during SPT (p = 0.83), with 2% for U-NTG and 3% for F-NTG. In the U-NTG group, the positive induction rate of coronary spasm in another coronary artery was 40% (17/42). Conclusions: The unavoidable use of NTG occurred in ~30% of patients with VSA, most of whom were current smokers. It did not decrease the detection of MVS and potentially prevented severe complications during SPT. Therefore, the unavoidable use of NTG is acceptable during SPT. However, an additional test may need to be performed to assess the presence of MVS.

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Section: Discussionmentioning

confidence: 99%

“…We conducted the SPT using the previously published procedures [ 11 , 12 , 13 , 14 ]. Briefly, in the SPT for the RCA, 20 and 50 µg ACh were injected into the RCA following the initial coronary angiogram (CAG).…”

Section: Methodsmentioning

confidence: 99%

Clinical Characteristics and Prognosis of Patients with Vasospastic Angina Subjected to the Spasm Provocation Test and the Unavoidable Use of Nitroglycerin

Teragawa

Oshita

Uchimura

2023

JCDD

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“…The CAG and SPT methods are well documented, 26 and the typical approach at the authors’ institution is as follows: The right coronary artery (RCA) was assessed by administering 20, 50, and 80 µg of acetylcholine (ACh) at twenty-second and three-minute intervals; for the left coronary artery (LCA), 50, 100, or 200 µg of ACh was administered every three minutes for 20 seconds; if VSA activity was high, then a smaller dose was administered. As previously reported, 26 SPT was started in the RCA at the authors’ institution until April 2016; thereafter, SPT was started in the LCA. If ACh does not induce coronary spasms, then either methylergometrine maleate or additional ACh provocation was performed as needed.…”

Section: Methodsmentioning

confidence: 99%

“…Quantitative CAG has previously been described. 26 An atherosclerotic lesion was defined as coronary artery stenosis >20% and <50%. Significant stenosis was defined as stenosis >50% and an FFR of ≤0.8; these patients were excluded from the study as previously noted.…”

Section: Methodsmentioning

confidence: 99%

Clinical Characteristics and Major Adverse Cardiovascular Events in Diabetic and Non-Diabetic Patients with Vasospastic Angina

Teragawa,

Uchimura,

Oshita

et al. 2024

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Purpose The clinical background and prognostic impact of diabetes mellitus (DM) on vasospastic angina (VSA) are unclear; thus, in this retrospective study, we investigated whether they differ based on the presence or absence of DM in patients with VSA. Patients and Methods We included 272 Japanese patients with VSA diagnosed by coronary angiography (CAG) and the spasm provocation test (SPT). The diagnosis of DM was determined by measuring fasting blood glucose and hemoglobin A1C and by the patient’s current oral medications. On CAG, the presence of atherosclerotic lesions (20%–50%) was checked. On SPT, the coronary spasm was defined as transient coronary vasoconstriction >90% on CAG, accompanied by chest symptoms and/or ST-T changes. Focal spasm was defined as coronary spasm occurring within one segment of the American Heart Association classification on CAG. Blood and urine tests and vascular endothelial function were also evaluated when possible. A major adverse cardiovascular event (MACE), which is defined as cardiac mortality and rehospitalization due to cardiovascular illness, was the basis for determining the prognosis. Results There were 49 patients (18%) in the DM group and 223 (82%) in the non-DM group. No significant differences in urinary albumin levels and peripheral vascular function were between groups. On CAG, atherosclerotic lesions were observed significantly more frequently in the DM group (63% vs 46%; P = 0.028). Results of SPT showed a trend toward fewer focal spasms in the DM group (24% vs 39%; P = 0.072). No significant differences in MACE were noted between groups in the primary analysis of DM, whereas sub-analyses of focal spasms showed lower MACE-free survival in the DM group (P = 0.042). Conclusion The study results support the hypothesis that DM associated with VSA should be treated appropriately, especially in cases of focal spasm, which may require more attention in treatment.

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“…Multivessel spasms (MVS) were defined as coronary spasms that occurred in ≥ 2 major coronary arteries. For multivessel spasms, we could not assess when the subsequent SPT was negative after an unavoidable use of NTG[ 16 ]. Regarding the presence of coronary spasm per vessel, the frequency of coronary spasms in the left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), and RCA were reviewed.…”

Section: Methodsmentioning

confidence: 99%

Vasospastic angina in women: Clinical backgrounds and prognoses of patients younger than and older than 60 years

Teragawa¹,

Oshita²,

Uchimura³

2023

World J Cardiol

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BACKGROUND We frequently encounter cases of women with vasospastic angina (VSA). Additionally, some women with VSA are younger than 60 years old. However, it is unknown whether the characteristics of VSA in women aged < 60 years are different from those in women aged ≥ 60 years. AIM To investigate and compare the clinical characteristics and prognosis of VSA in women aged < 60 years from those in women aged ≥ 60 years. METHODS We enrolled 94 women with VSA who were diagnosed using the spasm provocation test. According to the age at diagnosis, the patients were divided into two groups: Group Y (age < 60 years, n = 17) and Group O (age ≥ 60 years, n = 77). Flow-mediated dilation (FMD) and nitroglycerin (NTG)-induced dilation (NID) of the brachial artery were performed and assessed using brachial ultrasonography. Moreover, conventional coronary risk factors, such as atherosclerotic lesions (stenosis > 20%) detected using coronary angiography and focal spasms (coronary spasm within one segment of one coronary artery), and major cardiovascular adverse events (MACE) were assessed in both groups. RESULTS Smoking was more prevalent in Group Y than in Group O ( P = 0.04). FMD was similar in both groups (Group O: 4.3% ± 3.2%, Group Y: 4.5% ± 3.3%; P = 0.75), whereas NID was higher in Group Y (20.5% ± 8.6%) than in Group O (13.6% ± 5.3%, P < 0.01). Atherosclerosis was not detected in Group Y but was detected in Group O (61%, P < 0.01). Focal spasms were less frequent in Group Y (12%) than in Group O (38%, P = 0.04). The incidence of major adverse cardiac events did not differ between the two groups (P = 0.40). CONCLUSION Women aged < 60 years with VSA have less atherosclerotic lesions and focal spasms. These characteristics may be affected by smoking habits and vascular smooth muscle dysfunction.

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Clinical Characteristics and Prognosis of Patients with Multi-Vessel Coronary Spasm in Comparison with Those in Patients with Single-Vessel Coronary Spasm

Cited by 8 publications

References 35 publications

Clinical Characteristics and Prognosis of Patients with Vasospastic Angina Subjected to the Spasm Provocation Test and the Unavoidable Use of Nitroglycerin

Clinical Characteristics and Prognosis of Patients with Vasospastic Angina Subjected to the Spasm Provocation Test and the Unavoidable Use of Nitroglycerin

Clinical Characteristics and Major Adverse Cardiovascular Events in Diabetic and Non-Diabetic Patients with Vasospastic Angina

Vasospastic angina in women: Clinical backgrounds and prognoses of patients younger than and older than 60 years

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