Hoshino Masahiro, Yonetsu Taishi, Mizukami Akira, Matsuda Yuji, Yoshioka Kenji, Sudo Yuta, Ninomiya Ryo, Soeda Masao, Kuroda Shunsuke, Ono Maki, Iwatsuka Ryota, Suzuki Makoto, Matsumura Akihiko, Hashimoto Yuji
Department of Cardiology, Kameda Medical Center, 929 Higashi-cho Kamogawa City, Chiba, 296-8602, Japan.
Heart Vessels. 2016 Dec;31(12):1943-1949. doi: 10.1007/s00380-016-0827-9. Epub 2016 Mar 11.
The acetylcholine (ACh) provocation test (ACh-test) is used for the diagnosis of vasospastic angina (VSA). However, subjects often show a moderate spasm (MS) response for which diagnosis of VSA is not definitive, and the clinical significance of this response is unknown. We assessed moderate coronary vasomotor response to the ACh test as an indicator of long-term prognosis. A total of 298 consecutive patients who underwent the ACh test for suspected VSA were retrospectively investigated. Coronary spasm severity after intracoronary administration of isosorbide dinitrate was evaluated by measuring epicardial coronary artery diameter reduction after ACh injection. Patients were divided into three groups according to the diameter reduction during the ACh test: severe spasm (SS) showing ≥75 % diameter reduction, MS showing ≥50 % diameter reduction, and others (N). In Kaplan-Meier analysis, the major adverse cardiac event (MACE) rates with a median follow-up of 4.6 years were significantly worse in SS (11.1 %) and MS (8.5 %) than N (1.9 %), (SS vs N; P = 0.009, MS vs N; P = 0.029). Significant difference in MACE rates was not observed between SS and MS (P = 0.534). Cox regression analysis revealed that MS remained an independent predictor of MACE after adjustment for other confounders (HR: 7.18, 95 % CI 1.42-36.4, P = 0.017). Patients with MS by ACh test had a cardiac event rate comparable with that of patients with SS and significantly worse than that of patients with normal vasomotor responses.
乙酰胆碱激发试验（ACh试验）用于诊断血管痉挛性心绞痛（VSA）。然而，受试者常表现出中度痉挛（MS）反应，而VSA的诊断并不明确，且这种反应的临床意义尚不清楚。我们评估了ACh试验的中度冠状动脉血管舒缩反应作为长期预后的指标。对连续298例因疑似VSA接受ACh试验的患者进行回顾性研究。通过测量注射ACh后心外膜冠状动脉直径缩小来评估冠状动脉内给予硝酸异山梨酯后的冠状动脉痉挛严重程度。根据ACh试验期间的直径缩小情况将患者分为三组：严重痉挛（SS）组，直径缩小≥75%；MS组，直径缩小≥50%；其他组（N）。在Kaplan-Meier分析中，中位随访4.6年时，SS组（11.1%）和MS组（8.5%）的主要不良心脏事件（MACE）发生率显著高于N组（1.9%）（SS组与N组比较；P = 0.009，MS组与N组比较；P = 0.029）。SS组和MS组之间未观察到MACE发生率的显著差异（P = 0.534）。Cox回归分析显示，在调整其他混杂因素后，MS仍然是MACE的独立预测因素（HR：7.18，95%CI 1.42 - 36.4，P = 0.017）。ACh试验出现MS的患者的心脏事件发生率与SS组患者相当，且显著高于血管舒缩反应正常的患者。
