The multi-vessel and diffuse coronary spasm is a risk factor for persistent angina in patients received anti-angina medication

Abstract

Coronary artery spasm (CAS) is known to be a risk factor for cardiovascular events. However, there is limited data whether the multi-vessel and diffuse spasm (MVDS) is related to more adverse clinical outcomes compared to the Non-MVDS. The aim of this study is to evaluate the impact of the MVDS on clinical outcomes during a 3-year clinical follow-up period. A total 2797 patients underwent coronary angiography (CAG) with acetylcholine (ACH) provocation test from Nov 2004 to Oct 2010 were enrolled. It is a single-center, observational, prospective, all-comers registry designed to reflect the “real world” practic. The patients were divided into the 3 groups; the negative spasm (NS) group (n = 1188), the Non-MVDS group (n = 1081), and the MVDS group (n = 528). The incidence of major adverse cardiac events (MACE) and recurrent angina was evaluated up to 3 years. To minimize confounding factors, multivariable Cox-proportional hazards regression analysis was performed. In the 3-year clinical follow-up, the incidence of total death, myocardial infarction, de novo percutaneous coronary intervention (PCI), cerebrovascular accident and MACE were similar among the 3 groups. However, recurrent angina occurred more frequently in the MVDS group than in the NS group (hazard ratio [HR], 1.96; 95% confidence interval [CI], 1.27–3.02; P = .002). Recurrence angina between the MVDS group and the Non-MVDS group was not statistically significant (HR, 1.36; 95% CI, 0.91–2.03; P = .129). In this study, although the incidence of major adverse cardiovascular events were not different regardless of spasm type, the MVDS was associated with higher incidence of recurrent chest pain requiring repeat CAG during the 3-year follow-up period, suggesting more intensive optimal medical therapy with close clinical follow up would be necessary for this particular subset of patients.

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

“…24,39,40 The focus of the present study was on the effect of DM on focal spasm, which may be associated with such unstable plaques; therefore, a sub-analysis of patients with focal spasm was conducted, with the results suggesting that focal spasm may be less likely in the DM group. One report indicates that increased insulin resistance is associated with diffuse spasm, 41 partially supporting our results. In contrast, others report no difference in coronary spasm morphology depending on the presence or absence of DM.…”

Coronary artery spasm treated with intracoronary bioresorbable scaffold implantation under the guidance of treadmill test and optical coherence tomography: A case report

“…With the popularization of coronary interventional diagnosis and treatment, reports of acute myocardial infarction (AMI) caused by CAS are increasing. Statistics show that about 10% of patients with AMI have no significant coronary artery stenosis, and CAS is considered to be one of the main causes of AMI (Park et al, 2018). The study by (Gaspardone et al, 1999) showed that symptoms were successfully controlled in six of nine patients with drug‐resistant CAS after coronary stenting at 6 months of follow‐up.…”

Assessment of coronary spasms with transluminal attenuation gradient in coronary computed tomography angiography

“…Sato et al [29] analyzed 5-year clinical outcomes and showed that diffuse spasms showed fewer major adverse cardiovascular events and a better prognosis than focal spasms. Conversely, Park et al [30] analyzed 3 year clinical outcomes and found that diffuse coronary spasms were independent predictors of recurrent chest pain. Sueda et al [31] suggested that diffuse spasms had poor responses to medical treatment.…”