Impact of low-dose aspirin on coronary artery spasm as assessed by intracoronary acetylcholine provocation test in Korean patients

Abstract

High-dose aspirin has been reported to aggravate coronary artery spasm (CAS). However, it is unknown whether low-dose aspirin (LDA; 100 mg) has deleterious impact on CAS. We assessed the impact of LDA on CAS induced by intracoronary acetylcholine (ACh) provocation test. A total of 2789 consecutive patients without significant coronary artery disease who underwent ACh test between November 2004 and March 2010 were enrolled. The patients were divided into two groups: the aspirin group taking LDA before ACh test (n=221) and the no aspirin group not taking aspirin (n=2568). At baseline, the prevalence of old age, diabetes mellitus, hypertension, and hyperlipidemia were higher in the aspirin group. During the ACh test, the incidence of significant CAS, ischemic chest pain, as well as severe and multivessel spasm was higher in the aspirin group. The response rate to lower ACh dose was higher in the aspirin group. Multivariate analysis showed that the previous use of LDA was an independent predictor of CAS (adjusted odds ratio, 1.6, 95% confidence interval, 1.0-2.3; p=0.031). However, it is likely that the association of LDA and CAS that we have observed is not causal but may be hypothesis generating due to significant baseline differences. Further, male gender, old age, lipid-lowering drugs, baseline spasm, and myocardial bridge were independent predictors of CAS. LDA was more frequently associated with CAS and ischemic symptoms, as well as severe and multivessel spasm, suggesting the patients who have received LDA would require more intensive medical therapies and close follow up.

Angiographic and Clinical Characteristics according to Intracoronary Acetylcholine Dose in Patients with Myocardial Bridge

“…Fourth, according to the guideline for diagnosis and treatment of patients with vasospastic angina (Japanese Circulation Society, 2008), CAS was defined as ‘transient, total, or sub-total occlusion (>90% stenosis) of a coronary artery with signs/symptoms of myocardial ischemia (angina pain and ischemic ST changes)' [28]. However, we have modified the positive ACh provocation test criteria for patient's safety and efficacy, as published elsewhere [29,30]. We considered the patient's safety, convenience and efficacy in the real world practice because most of patients of this study underwent ACh provocation test on the basis of outpatient clinic via a 4-Fr transradial approach.…”

Impact of Renin‐Angiotensin System Inhibitors on Long‐Term Clinical Outcomes of Patients With Coronary Artery Spasm

“…The design of the Ach provocation test has been introduced before . An initial investigation for CAG included clinical history taking and noninvasive stress tests such as treadmill test, stress echocardiography, and radionuclide study.…”

The Impact of High Sensitivity C-Reactive Protein Level on Coronary Artery Spasm as Assessed by Intracoronary Acetylcholine Provocation Test

“…Among them, 2053 patients who had typical or atypical chest pain and had been diagnosed by coronary angiography with insignificant coronary artery disease (CAD), underwent intracoronary ACh provocation test. The exclusion criteria of this study was referenced with previous our studies 3,4. We excluded the patients with one of the following conditions such as prior coronary artery bypass graft, prior percutaneous coronary intervention, prior cerebrovascular disease, advanced heart failure (New York Heart Association class III or IV), or serum creatinine ≥3 mg/dL.…”

“…The method of acetylcholine provocation test in this study was referenced with previous our studies 3,4. Nitrates, calcium channel blockers (CCB), beta blockers (BB), angiotension-converting enzyme inhibitors (ACEI) and other vasodilators or vasoconstrictors was discontinued at least 72 hours before the coronary angiography.…”

“…The study definition of this study was referenced with previous our studies 3,4. Hypertension was defined with elevation of blood pressure ≥140/90 mm Hg or current treatment of antihypertensive drugs.…”