Five-year clinical outcomes in patients with significant coronary artery spasm: A propensity score-matched analysis

Byoung Geol Choi, Sang Ho Park, Seung Woon Rha, Ji Young Park, Se Yeon Choi, Yoonjee Park, Shaopeng Xu, Harris Abdullah Ngow, Jabar Ali, Hu Li, Ji Bak Kim, Sunki Lee, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh

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20 Citations (Scopus)


Background: Coronary artery spasm (CAS) is known to be a risk factor of acute coronary syndrome and angina pectoris. However, there is no currently available data with larger study population regarding long-term clinical outcomes of CAS in real world clinical practice. Objectives: We evaluated the prevalence of CAS and the impact of CAS on 5-year clinical outcomes in a series of Asian CAS patients documented by intracoronary acetylcholine (Ach) provocation test. Methods: A total of 1413 consecutive patients without significant coronary artery disease (CAD)who underwent Ach provocation test between Nov. 2004 and Oct. 2008 were enrolled. Significant CAS was defined as N70% of narrowing by incremental intracoronary injection of 20, 50 and 100 μg. Patients were divided into two groups based on the presence of significant CAS (the non-CAS group: n= 640, the CAS group; n= 773). To adjust potential confounders, a propensity score matched (PSM) analysis was performed using the logistic regreßion model. Results: A total of 54.7% (773/1413) patients were diagnosed as CAS documented by Ach provocation test. After PSM analysis, 2 propensity-matched groups (451 pairs, n=902, C-statistic=0.677)were generated. Despite of similar incidence of individual hard endpoints including mortality, myocardial infarction and revascularization, the CAS group showed the higher trend of recurrent angina requiring follow up angiography than the non-CAS group up to 5 years (HR; 1.56, 95% C.I.; 0.99-2.46, p = 0.054). Conclusions: The prevalence of CAS was 54.7%. Although the cumulative incidence of recurrent angina requiring follow up coronary angiography seems to be increased up to 5 years in CAS patients, CAS patients was not aßociated with major individual and composite clinical outcomes such as mortality, MI, PCI, CVA with optimal medical therapy as compared with patients without CAS.

Original languageEnglish
Pages (from-to)533-539
Number of pages7
JournalInternational Journal of Cardiology
Issue number1
Publication statusPublished - 2015


  • Acetylcholine provocation test
  • Coronary artery spasm
  • Major clinical outcomes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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