Five-year major clinical outcomes according to severity of coronary artery spasm as assessed by intracoronary acetylcholine provocation test

Yong Hoon Kim, Ae Young Her, Seung-Woon Rha, Byoung Geol Choi, Minsuk Shim, Se Yeon Choi, Jae Kyeong Byun, Hu Li, Woohyeun Kim, Jun Hyuk Kang, Jah Yeon Choi, Eun Jin Park, Sung Hun Park, Sunki Lee, Jin Oh Na, Cheol Ung Choi, Hong Euy Lim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo & 1 others Dong Joo Oh

Research output: Contribution to journalArticle

Abstract

Background: Long-term clinical outcome data according to severity of coronary artery spasm (CAS) as assessed by an intracoronary acetylcholine provocation test are limited in series of Asian patients. Aim: To investigate 5-year clinical outcomes in patients with CAS according to CAS severity. Methods: In total, 5873 consecutive patients with insignificant coronary artery disease (<. 70% fixed stenosis) who underwent an acetylcholine provocation test were enrolled and divided into four groups according to CAS severity during the acetylcholine provocation test: negative, borderline positive, moderately positive and severely positive. CAS severity was assessed by quantitative coronary angiography. We investigated 5-year clinical outcomes according to CAS severity. Results: Over a follow-up period of up to 5 years, before adjustment, the severely-positive CAS group showed a significantly higher incidence of major adverse cardiac events (MACE; composite of death, myocardial infarction and de novo revascularization) (hazard ratio [HR]: 1.834, 95% confidence interval [CI]: 1.047-3.211; P = 0.033), total death (HR: 3.124, 95% CI: 1.047-9.322; P = 0.041), myocardial infarction (HR: 3.190, 95% CI: 1.069-9.519; P = 0.037) and recurrent angina (HR: 1.762, 95% CI: 1.363-2.278; P <. 0.001) compared with the negative group. However, after adjustment for baseline confounders, only the incidence of recurrent angina (HR: 1.323, 95% CI: 1.014-1.726; P = 0.039) was significantly higher in the severely-positive CAS group compared with the negative group. Conclusions: The severity of CAS in the positive group was not associated with an increased incidence of MACE after adjustment for covariates compared with the negative group, but the severely-positive CAS group was associated with a higher incidence of recurrent angina compared with the negative group.

Original languageEnglish
JournalArchives of Cardiovascular Diseases
DOIs
Publication statusAccepted/In press - 2017

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Spasm
Acetylcholine
Coronary Vessels
Confidence Intervals
Incidence
Myocardial Infarction
Coronary Angiography
Coronary Artery Disease
Pathologic Constriction

Keywords

  • Acetylcholine
  • Clinical outcomes
  • Coronary artery spasm

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Five-year major clinical outcomes according to severity of coronary artery spasm as assessed by intracoronary acetylcholine provocation test. / Kim, Yong Hoon; Her, Ae Young; Rha, Seung-Woon; Choi, Byoung Geol; Shim, Minsuk; Choi, Se Yeon; Byun, Jae Kyeong; Li, Hu; Kim, Woohyeun; Kang, Jun Hyuk; Choi, Jah Yeon; Park, Eun Jin; Park, Sung Hun; Lee, Sunki; Na, Jin Oh; Choi, Cheol Ung; Lim, Hong Euy; Kim, Eung Ju; Park, Chang Gyu; Seo, Hong Seog; Oh, Dong Joo.

In: Archives of Cardiovascular Diseases, 2017.

Research output: Contribution to journalArticle

Kim, Yong Hoon ; Her, Ae Young ; Rha, Seung-Woon ; Choi, Byoung Geol ; Shim, Minsuk ; Choi, Se Yeon ; Byun, Jae Kyeong ; Li, Hu ; Kim, Woohyeun ; Kang, Jun Hyuk ; Choi, Jah Yeon ; Park, Eun Jin ; Park, Sung Hun ; Lee, Sunki ; Na, Jin Oh ; Choi, Cheol Ung ; Lim, Hong Euy ; Kim, Eung Ju ; Park, Chang Gyu ; Seo, Hong Seog ; Oh, Dong Joo. / Five-year major clinical outcomes according to severity of coronary artery spasm as assessed by intracoronary acetylcholine provocation test. In: Archives of Cardiovascular Diseases. 2017.
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title = "Five-year major clinical outcomes according to severity of coronary artery spasm as assessed by intracoronary acetylcholine provocation test",
abstract = "Background: Long-term clinical outcome data according to severity of coronary artery spasm (CAS) as assessed by an intracoronary acetylcholine provocation test are limited in series of Asian patients. Aim: To investigate 5-year clinical outcomes in patients with CAS according to CAS severity. Methods: In total, 5873 consecutive patients with insignificant coronary artery disease (<. 70{\%} fixed stenosis) who underwent an acetylcholine provocation test were enrolled and divided into four groups according to CAS severity during the acetylcholine provocation test: negative, borderline positive, moderately positive and severely positive. CAS severity was assessed by quantitative coronary angiography. We investigated 5-year clinical outcomes according to CAS severity. Results: Over a follow-up period of up to 5 years, before adjustment, the severely-positive CAS group showed a significantly higher incidence of major adverse cardiac events (MACE; composite of death, myocardial infarction and de novo revascularization) (hazard ratio [HR]: 1.834, 95{\%} confidence interval [CI]: 1.047-3.211; P = 0.033), total death (HR: 3.124, 95{\%} CI: 1.047-9.322; P = 0.041), myocardial infarction (HR: 3.190, 95{\%} CI: 1.069-9.519; P = 0.037) and recurrent angina (HR: 1.762, 95{\%} CI: 1.363-2.278; P <. 0.001) compared with the negative group. However, after adjustment for baseline confounders, only the incidence of recurrent angina (HR: 1.323, 95{\%} CI: 1.014-1.726; P = 0.039) was significantly higher in the severely-positive CAS group compared with the negative group. Conclusions: The severity of CAS in the positive group was not associated with an increased incidence of MACE after adjustment for covariates compared with the negative group, but the severely-positive CAS group was associated with a higher incidence of recurrent angina compared with the negative group.",
keywords = "Acetylcholine, Clinical outcomes, Coronary artery spasm",
author = "Kim, {Yong Hoon} and Her, {Ae Young} and Seung-Woon Rha and Choi, {Byoung Geol} and Minsuk Shim and Choi, {Se Yeon} and Byun, {Jae Kyeong} and Hu Li and Woohyeun Kim and Kang, {Jun Hyuk} and Choi, {Jah Yeon} and Park, {Eun Jin} and Park, {Sung Hun} and Sunki Lee and Na, {Jin Oh} and Choi, {Cheol Ung} and Lim, {Hong Euy} and Kim, {Eung Ju} and Park, {Chang Gyu} and Seo, {Hong Seog} and Oh, {Dong Joo}",
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T1 - Five-year major clinical outcomes according to severity of coronary artery spasm as assessed by intracoronary acetylcholine provocation test

AU - Kim, Yong Hoon

AU - Her, Ae Young

AU - Rha, Seung-Woon

AU - Choi, Byoung Geol

AU - Shim, Minsuk

AU - Choi, Se Yeon

AU - Byun, Jae Kyeong

AU - Li, Hu

AU - Kim, Woohyeun

AU - Kang, Jun Hyuk

AU - Choi, Jah Yeon

AU - Park, Eun Jin

AU - Park, Sung Hun

AU - Lee, Sunki

AU - Na, Jin Oh

AU - Choi, Cheol Ung

AU - Lim, Hong Euy

AU - Kim, Eung Ju

AU - Park, Chang Gyu

AU - Seo, Hong Seog

AU - Oh, Dong Joo

PY - 2017

Y1 - 2017

N2 - Background: Long-term clinical outcome data according to severity of coronary artery spasm (CAS) as assessed by an intracoronary acetylcholine provocation test are limited in series of Asian patients. Aim: To investigate 5-year clinical outcomes in patients with CAS according to CAS severity. Methods: In total, 5873 consecutive patients with insignificant coronary artery disease (<. 70% fixed stenosis) who underwent an acetylcholine provocation test were enrolled and divided into four groups according to CAS severity during the acetylcholine provocation test: negative, borderline positive, moderately positive and severely positive. CAS severity was assessed by quantitative coronary angiography. We investigated 5-year clinical outcomes according to CAS severity. Results: Over a follow-up period of up to 5 years, before adjustment, the severely-positive CAS group showed a significantly higher incidence of major adverse cardiac events (MACE; composite of death, myocardial infarction and de novo revascularization) (hazard ratio [HR]: 1.834, 95% confidence interval [CI]: 1.047-3.211; P = 0.033), total death (HR: 3.124, 95% CI: 1.047-9.322; P = 0.041), myocardial infarction (HR: 3.190, 95% CI: 1.069-9.519; P = 0.037) and recurrent angina (HR: 1.762, 95% CI: 1.363-2.278; P <. 0.001) compared with the negative group. However, after adjustment for baseline confounders, only the incidence of recurrent angina (HR: 1.323, 95% CI: 1.014-1.726; P = 0.039) was significantly higher in the severely-positive CAS group compared with the negative group. Conclusions: The severity of CAS in the positive group was not associated with an increased incidence of MACE after adjustment for covariates compared with the negative group, but the severely-positive CAS group was associated with a higher incidence of recurrent angina compared with the negative group.

AB - Background: Long-term clinical outcome data according to severity of coronary artery spasm (CAS) as assessed by an intracoronary acetylcholine provocation test are limited in series of Asian patients. Aim: To investigate 5-year clinical outcomes in patients with CAS according to CAS severity. Methods: In total, 5873 consecutive patients with insignificant coronary artery disease (<. 70% fixed stenosis) who underwent an acetylcholine provocation test were enrolled and divided into four groups according to CAS severity during the acetylcholine provocation test: negative, borderline positive, moderately positive and severely positive. CAS severity was assessed by quantitative coronary angiography. We investigated 5-year clinical outcomes according to CAS severity. Results: Over a follow-up period of up to 5 years, before adjustment, the severely-positive CAS group showed a significantly higher incidence of major adverse cardiac events (MACE; composite of death, myocardial infarction and de novo revascularization) (hazard ratio [HR]: 1.834, 95% confidence interval [CI]: 1.047-3.211; P = 0.033), total death (HR: 3.124, 95% CI: 1.047-9.322; P = 0.041), myocardial infarction (HR: 3.190, 95% CI: 1.069-9.519; P = 0.037) and recurrent angina (HR: 1.762, 95% CI: 1.363-2.278; P <. 0.001) compared with the negative group. However, after adjustment for baseline confounders, only the incidence of recurrent angina (HR: 1.323, 95% CI: 1.014-1.726; P = 0.039) was significantly higher in the severely-positive CAS group compared with the negative group. Conclusions: The severity of CAS in the positive group was not associated with an increased incidence of MACE after adjustment for covariates compared with the negative group, but the severely-positive CAS group was associated with a higher incidence of recurrent angina compared with the negative group.

KW - Acetylcholine

KW - Clinical outcomes

KW - Coronary artery spasm

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