A comparison of clinical features of coronary artery spasm with and without thyrotoxicosis

Soo Youn Lee, Cheol Woong Yu, Young Jin Choi, Rak Kyeong Choi, Jin Sik Park, Hyun Jong Lee, Je Sang Kim, Ho Jun Jang, Duck Hyun Jang, Myung Joon Chae, Won Heum Shim, Young Moo Ro

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

OBJECTIVE: Several reports have suggested that thyrotoxicosis may induce severe coronary artery spasm (CAS). However, there are few data regarding the differences in clinical characteristics of CAS with and without thyrotoxicosis. The aim of our study is to compare the clinical features of CAS with and without thyrotoxicosis. METHODS: We evaluated 430 consecutive patients with CAS [patients with thyrotoxicosis (N=32, group I) and those without (N=398, group II)] at a single institute between January 2001 and June 2011. We compared clinical presentations, angiographic findings, and adverse outcomes (a composite outcome of cardiac death, myocardial infarction, or rehospitalization due to cardiac cause) of both groups. RESULTS: There was higher incidence of acute myocardial infarction at initial presentation in group I (15.6 vs. 5.8%, P=0.04). CAS with thyrotoxicosis was more diffuse (59.4 vs. 39.3%, P=0.03), more medically intractable (9.4 vs. 0%, P=0.001), and more frequently involved the left main vessel (25.0 vs.0.8%, P=0.001) than CAS without thyrotoxicosis. During the follow-up period (median 43 months), there were no significant differences between the two groups in terms of the risk of adverse outcomes (hazard ratio for CAS with thyrotoxicosis, 1.029; 95% confidence interval, 0.347-3.054). CONCLUSION: Clinical and angiographic presentations of CAS with thyrotoxicosis were more severe than CAS without thyrotoxicosis, but clinical outcomes were similar in both groups. Optimal vasodilator therapy is essential for the management of CAS with thyrotoxicosis. Thyroid function test should be mandatory for all patients with CAS.

Original languageEnglish
Pages (from-to)125-132
Number of pages8
JournalCoronary Artery Disease
Volume25
Issue number2
DOIs
Publication statusPublished - 2014 Mar 1
Externally publishedYes

Fingerprint

Thyrotoxicosis
Spasm
Coronary Vessels
Myocardial Infarction
Thyroid Function Tests
Vasodilator Agents
Confidence Intervals

Keywords

  • coronary artery spasm
  • thyrotoxicosis
  • vasospastic angina

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

A comparison of clinical features of coronary artery spasm with and without thyrotoxicosis. / Lee, Soo Youn; Yu, Cheol Woong; Choi, Young Jin; Choi, Rak Kyeong; Park, Jin Sik; Lee, Hyun Jong; Kim, Je Sang; Jang, Ho Jun; Jang, Duck Hyun; Chae, Myung Joon; Shim, Won Heum; Ro, Young Moo.

In: Coronary Artery Disease, Vol. 25, No. 2, 01.03.2014, p. 125-132.

Research output: Contribution to journalArticle

Lee, SY, Yu, CW, Choi, YJ, Choi, RK, Park, JS, Lee, HJ, Kim, JS, Jang, HJ, Jang, DH, Chae, MJ, Shim, WH & Ro, YM 2014, 'A comparison of clinical features of coronary artery spasm with and without thyrotoxicosis', Coronary Artery Disease, vol. 25, no. 2, pp. 125-132. https://doi.org/10.1097/MCA.0000000000000069
Lee, Soo Youn ; Yu, Cheol Woong ; Choi, Young Jin ; Choi, Rak Kyeong ; Park, Jin Sik ; Lee, Hyun Jong ; Kim, Je Sang ; Jang, Ho Jun ; Jang, Duck Hyun ; Chae, Myung Joon ; Shim, Won Heum ; Ro, Young Moo. / A comparison of clinical features of coronary artery spasm with and without thyrotoxicosis. In: Coronary Artery Disease. 2014 ; Vol. 25, No. 2. pp. 125-132.
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abstract = "OBJECTIVE: Several reports have suggested that thyrotoxicosis may induce severe coronary artery spasm (CAS). However, there are few data regarding the differences in clinical characteristics of CAS with and without thyrotoxicosis. The aim of our study is to compare the clinical features of CAS with and without thyrotoxicosis. METHODS: We evaluated 430 consecutive patients with CAS [patients with thyrotoxicosis (N=32, group I) and those without (N=398, group II)] at a single institute between January 2001 and June 2011. We compared clinical presentations, angiographic findings, and adverse outcomes (a composite outcome of cardiac death, myocardial infarction, or rehospitalization due to cardiac cause) of both groups. RESULTS: There was higher incidence of acute myocardial infarction at initial presentation in group I (15.6 vs. 5.8{\%}, P=0.04). CAS with thyrotoxicosis was more diffuse (59.4 vs. 39.3{\%}, P=0.03), more medically intractable (9.4 vs. 0{\%}, P=0.001), and more frequently involved the left main vessel (25.0 vs.0.8{\%}, P=0.001) than CAS without thyrotoxicosis. During the follow-up period (median 43 months), there were no significant differences between the two groups in terms of the risk of adverse outcomes (hazard ratio for CAS with thyrotoxicosis, 1.029; 95{\%} confidence interval, 0.347-3.054). CONCLUSION: Clinical and angiographic presentations of CAS with thyrotoxicosis were more severe than CAS without thyrotoxicosis, but clinical outcomes were similar in both groups. Optimal vasodilator therapy is essential for the management of CAS with thyrotoxicosis. Thyroid function test should be mandatory for all patients with CAS.",
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AU - Lee, Soo Youn

AU - Yu, Cheol Woong

AU - Choi, Young Jin

AU - Choi, Rak Kyeong

AU - Park, Jin Sik

AU - Lee, Hyun Jong

AU - Kim, Je Sang

AU - Jang, Ho Jun

AU - Jang, Duck Hyun

AU - Chae, Myung Joon

AU - Shim, Won Heum

AU - Ro, Young Moo

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N2 - OBJECTIVE: Several reports have suggested that thyrotoxicosis may induce severe coronary artery spasm (CAS). However, there are few data regarding the differences in clinical characteristics of CAS with and without thyrotoxicosis. The aim of our study is to compare the clinical features of CAS with and without thyrotoxicosis. METHODS: We evaluated 430 consecutive patients with CAS [patients with thyrotoxicosis (N=32, group I) and those without (N=398, group II)] at a single institute between January 2001 and June 2011. We compared clinical presentations, angiographic findings, and adverse outcomes (a composite outcome of cardiac death, myocardial infarction, or rehospitalization due to cardiac cause) of both groups. RESULTS: There was higher incidence of acute myocardial infarction at initial presentation in group I (15.6 vs. 5.8%, P=0.04). CAS with thyrotoxicosis was more diffuse (59.4 vs. 39.3%, P=0.03), more medically intractable (9.4 vs. 0%, P=0.001), and more frequently involved the left main vessel (25.0 vs.0.8%, P=0.001) than CAS without thyrotoxicosis. During the follow-up period (median 43 months), there were no significant differences between the two groups in terms of the risk of adverse outcomes (hazard ratio for CAS with thyrotoxicosis, 1.029; 95% confidence interval, 0.347-3.054). CONCLUSION: Clinical and angiographic presentations of CAS with thyrotoxicosis were more severe than CAS without thyrotoxicosis, but clinical outcomes were similar in both groups. Optimal vasodilator therapy is essential for the management of CAS with thyrotoxicosis. Thyroid function test should be mandatory for all patients with CAS.

AB - OBJECTIVE: Several reports have suggested that thyrotoxicosis may induce severe coronary artery spasm (CAS). However, there are few data regarding the differences in clinical characteristics of CAS with and without thyrotoxicosis. The aim of our study is to compare the clinical features of CAS with and without thyrotoxicosis. METHODS: We evaluated 430 consecutive patients with CAS [patients with thyrotoxicosis (N=32, group I) and those without (N=398, group II)] at a single institute between January 2001 and June 2011. We compared clinical presentations, angiographic findings, and adverse outcomes (a composite outcome of cardiac death, myocardial infarction, or rehospitalization due to cardiac cause) of both groups. RESULTS: There was higher incidence of acute myocardial infarction at initial presentation in group I (15.6 vs. 5.8%, P=0.04). CAS with thyrotoxicosis was more diffuse (59.4 vs. 39.3%, P=0.03), more medically intractable (9.4 vs. 0%, P=0.001), and more frequently involved the left main vessel (25.0 vs.0.8%, P=0.001) than CAS without thyrotoxicosis. During the follow-up period (median 43 months), there were no significant differences between the two groups in terms of the risk of adverse outcomes (hazard ratio for CAS with thyrotoxicosis, 1.029; 95% confidence interval, 0.347-3.054). CONCLUSION: Clinical and angiographic presentations of CAS with thyrotoxicosis were more severe than CAS without thyrotoxicosis, but clinical outcomes were similar in both groups. Optimal vasodilator therapy is essential for the management of CAS with thyrotoxicosis. Thyroid function test should be mandatory for all patients with CAS.

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KW - thyrotoxicosis

KW - vasospastic angina

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