Impact of vasomotion type on prognosis of coronary artery spasm induced by acetylcholine provocation test of left coronary artery

Eun Mi Lee, Man Ho Choi, Hong Seog Seo, Hyun Ki Kim, Nam Ho Kim, Cheol Ung Choi, Jin Won Kim, Hong Euy Lim, Eung Ju Kim, Seung-Woon Rha, Chang Gyu Park, Dong Joo Oh

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background and aims The impact of vasomotion types on long-term clinical outcomes in patients with coronary artery spasm (CAS) induced by the acetylcholine provocation test (ACH-test) remains unclear. Methods We evaluated 4644 consecutive patients with typical resting chest pain (CP), but no angiographically significant coronary artery lesion (<50% stenosis), who underwent an ACH-test. According to their vasomotor response, patients were categorized into four types: normal vasomotion (no CP, no ischemic electrocardiographic changes, and no vasoconstriction), microvascular spasm (CP with <75% vasoconstriction but with CP relief after nitroglycerin infusion), epicardial spasm (CP with ≥75% vasoconstriction), and ACH-test inconclusive (vasoconstriction and/or electrocardiographic changes, but no CP). We investigated CP recurrence requiring follow-up angiography and major adverse cardiovascular events (MACEs) during 5 years. Results CP recurred in 7.9% of patients and was more frequent in abnormal vasomotion types (normal vasomotion, microvascular spasm, epicardial spasm, and inconclusive type: 5.4%, 9.8%, 10.9%, and 8.2%, respectively, log-rank p = 0.009). In multivariate analysis adjusted for medication use after the ACH-test, vasomotion subtype was not an independent predictor, whereas male sex, fixed lesion on baseline angiography, and medications including calcium channel blockers (CCBs), nitrates, and statins were independent positive predictors for recurrent CP. Alcohol consumption at the initial interview was a negative predictor. MACEs were observed in 1.6%, and the incidence was similar among subtypes (p = 0.421). Conclusions Recurrent CP and long-term outcomes are independent of vasomotion subtypes, but long-term use of CCBs, nitrates, and statins is a significant predictor for recurrent CP.

Original languageEnglish
Pages (from-to)195-200
Number of pages6
JournalAtherosclerosis
Volume257
DOIs
Publication statusPublished - 2017 Feb 1

Fingerprint

Spasm
Chest Pain
Acetylcholine
Coronary Vessels
Vasoconstriction
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Calcium Channel Blockers
Nitrates
Angiography
Nitroglycerin
Alcohol Drinking
Pathologic Constriction
Multivariate Analysis
Interviews
Recurrence

Keywords

  • Acetylcholine provocation test
  • Coronary artery spasm
  • Long-term clinical outcome
  • Vasomotion type

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of vasomotion type on prognosis of coronary artery spasm induced by acetylcholine provocation test of left coronary artery. / Lee, Eun Mi; Choi, Man Ho; Seo, Hong Seog; Kim, Hyun Ki; Kim, Nam Ho; Choi, Cheol Ung; Kim, Jin Won; Lim, Hong Euy; Kim, Eung Ju; Rha, Seung-Woon; Park, Chang Gyu; Oh, Dong Joo.

In: Atherosclerosis, Vol. 257, 01.02.2017, p. 195-200.

Research output: Contribution to journalArticle

@article{e2531f4be9f14fc5b36ad365551b7659,
title = "Impact of vasomotion type on prognosis of coronary artery spasm induced by acetylcholine provocation test of left coronary artery",
abstract = "Background and aims The impact of vasomotion types on long-term clinical outcomes in patients with coronary artery spasm (CAS) induced by the acetylcholine provocation test (ACH-test) remains unclear. Methods We evaluated 4644 consecutive patients with typical resting chest pain (CP), but no angiographically significant coronary artery lesion (<50{\%} stenosis), who underwent an ACH-test. According to their vasomotor response, patients were categorized into four types: normal vasomotion (no CP, no ischemic electrocardiographic changes, and no vasoconstriction), microvascular spasm (CP with <75{\%} vasoconstriction but with CP relief after nitroglycerin infusion), epicardial spasm (CP with ≥75{\%} vasoconstriction), and ACH-test inconclusive (vasoconstriction and/or electrocardiographic changes, but no CP). We investigated CP recurrence requiring follow-up angiography and major adverse cardiovascular events (MACEs) during 5 years. Results CP recurred in 7.9{\%} of patients and was more frequent in abnormal vasomotion types (normal vasomotion, microvascular spasm, epicardial spasm, and inconclusive type: 5.4{\%}, 9.8{\%}, 10.9{\%}, and 8.2{\%}, respectively, log-rank p = 0.009). In multivariate analysis adjusted for medication use after the ACH-test, vasomotion subtype was not an independent predictor, whereas male sex, fixed lesion on baseline angiography, and medications including calcium channel blockers (CCBs), nitrates, and statins were independent positive predictors for recurrent CP. Alcohol consumption at the initial interview was a negative predictor. MACEs were observed in 1.6{\%}, and the incidence was similar among subtypes (p = 0.421). Conclusions Recurrent CP and long-term outcomes are independent of vasomotion subtypes, but long-term use of CCBs, nitrates, and statins is a significant predictor for recurrent CP.",
keywords = "Acetylcholine provocation test, Coronary artery spasm, Long-term clinical outcome, Vasomotion type",
author = "Lee, {Eun Mi} and Choi, {Man Ho} and Seo, {Hong Seog} and Kim, {Hyun Ki} and Kim, {Nam Ho} and Choi, {Cheol Ung} and Kim, {Jin Won} and Lim, {Hong Euy} and Kim, {Eung Ju} and Seung-Woon Rha and Park, {Chang Gyu} and Oh, {Dong Joo}",
year = "2017",
month = "2",
day = "1",
doi = "10.1016/j.atherosclerosis.2016.09.015",
language = "English",
volume = "257",
pages = "195--200",
journal = "Atherosclerosis",
issn = "0021-9150",
publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Impact of vasomotion type on prognosis of coronary artery spasm induced by acetylcholine provocation test of left coronary artery

AU - Lee, Eun Mi

AU - Choi, Man Ho

AU - Seo, Hong Seog

AU - Kim, Hyun Ki

AU - Kim, Nam Ho

AU - Choi, Cheol Ung

AU - Kim, Jin Won

AU - Lim, Hong Euy

AU - Kim, Eung Ju

AU - Rha, Seung-Woon

AU - Park, Chang Gyu

AU - Oh, Dong Joo

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background and aims The impact of vasomotion types on long-term clinical outcomes in patients with coronary artery spasm (CAS) induced by the acetylcholine provocation test (ACH-test) remains unclear. Methods We evaluated 4644 consecutive patients with typical resting chest pain (CP), but no angiographically significant coronary artery lesion (<50% stenosis), who underwent an ACH-test. According to their vasomotor response, patients were categorized into four types: normal vasomotion (no CP, no ischemic electrocardiographic changes, and no vasoconstriction), microvascular spasm (CP with <75% vasoconstriction but with CP relief after nitroglycerin infusion), epicardial spasm (CP with ≥75% vasoconstriction), and ACH-test inconclusive (vasoconstriction and/or electrocardiographic changes, but no CP). We investigated CP recurrence requiring follow-up angiography and major adverse cardiovascular events (MACEs) during 5 years. Results CP recurred in 7.9% of patients and was more frequent in abnormal vasomotion types (normal vasomotion, microvascular spasm, epicardial spasm, and inconclusive type: 5.4%, 9.8%, 10.9%, and 8.2%, respectively, log-rank p = 0.009). In multivariate analysis adjusted for medication use after the ACH-test, vasomotion subtype was not an independent predictor, whereas male sex, fixed lesion on baseline angiography, and medications including calcium channel blockers (CCBs), nitrates, and statins were independent positive predictors for recurrent CP. Alcohol consumption at the initial interview was a negative predictor. MACEs were observed in 1.6%, and the incidence was similar among subtypes (p = 0.421). Conclusions Recurrent CP and long-term outcomes are independent of vasomotion subtypes, but long-term use of CCBs, nitrates, and statins is a significant predictor for recurrent CP.

AB - Background and aims The impact of vasomotion types on long-term clinical outcomes in patients with coronary artery spasm (CAS) induced by the acetylcholine provocation test (ACH-test) remains unclear. Methods We evaluated 4644 consecutive patients with typical resting chest pain (CP), but no angiographically significant coronary artery lesion (<50% stenosis), who underwent an ACH-test. According to their vasomotor response, patients were categorized into four types: normal vasomotion (no CP, no ischemic electrocardiographic changes, and no vasoconstriction), microvascular spasm (CP with <75% vasoconstriction but with CP relief after nitroglycerin infusion), epicardial spasm (CP with ≥75% vasoconstriction), and ACH-test inconclusive (vasoconstriction and/or electrocardiographic changes, but no CP). We investigated CP recurrence requiring follow-up angiography and major adverse cardiovascular events (MACEs) during 5 years. Results CP recurred in 7.9% of patients and was more frequent in abnormal vasomotion types (normal vasomotion, microvascular spasm, epicardial spasm, and inconclusive type: 5.4%, 9.8%, 10.9%, and 8.2%, respectively, log-rank p = 0.009). In multivariate analysis adjusted for medication use after the ACH-test, vasomotion subtype was not an independent predictor, whereas male sex, fixed lesion on baseline angiography, and medications including calcium channel blockers (CCBs), nitrates, and statins were independent positive predictors for recurrent CP. Alcohol consumption at the initial interview was a negative predictor. MACEs were observed in 1.6%, and the incidence was similar among subtypes (p = 0.421). Conclusions Recurrent CP and long-term outcomes are independent of vasomotion subtypes, but long-term use of CCBs, nitrates, and statins is a significant predictor for recurrent CP.

KW - Acetylcholine provocation test

KW - Coronary artery spasm

KW - Long-term clinical outcome

KW - Vasomotion type

UR - http://www.scopus.com/inward/record.url?scp=85010773924&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85010773924&partnerID=8YFLogxK

U2 - 10.1016/j.atherosclerosis.2016.09.015

DO - 10.1016/j.atherosclerosis.2016.09.015

M3 - Article

C2 - 28012648

AN - SCOPUS:85010773924

VL - 257

SP - 195

EP - 200

JO - Atherosclerosis

JF - Atherosclerosis

SN - 0021-9150

ER -