Clinical Outcomes of Vasospastic Angina Patients Presenting With Acute Coronary Syndrome

Abstract

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.

Out-of-hospital cardiac arrest related to coronary arterial spasm in three elderly patients with no obstructive coronary artery disease

“…We report three cases of OHCA due to RCA spasm in the presence of non-obstructive coronary artery disease in men over the age of 65 years. Significant predictors of MACE in CSA patients are (1) history of OHCA, (2) organic coronary stenosis, (3) multivessel spasm, (4) ST-segment elevation during angina, (5) smoking, (6) angina at rest alone, and (7) beta-blocker use [4][5][6][7][8]. The incidence of OHCA in Japanese CSA patients was 2.4%, which is 50-fold higher than that in the general population [9,10].…”

Coronary vasospasm-induced polymorphic ventricular tachycardia: a case report and literature review

“…It is important to recognize that this score was developed and validated in an East Asian population and to date its applicability to other ethnicities is not known. Patients with VSA who initially present as an acute coronary syndrome may also represent a group at higher risk for recurrent infarction 13 …”

Long-term outcomes of a Caucasian cohort presenting with acute coronary syndrome and/or out-of-hospital cardiac arrest caused by coronary spasm

“…In addition, another recent retrospective Korean cohort study by Cho et al. [ 22 ] described the follow-up in a large cohort of patients with vasospastic angina, as diagnosed with ergonovine provocation testing, presenting with ACS versus patients presenting without ACS. The study concluded that patients initially presenting with ACS had an increased risk of recurrent myocardial infarction and rehospitalisation because of recurrent angina.…”