Division of Cardiology, Department of Internal Medicine, Wonkwang University Sanbon Hospital, Gyeonggi-do 435-040, Republic of Korea.
Future Convergence Research Division, Korea Institute of Science and Technology, Seoul 136-791, Republic of Korea.
Atherosclerosis. 2017 Feb;257:195-200. doi: 10.1016/j.atherosclerosis.2016.09.015. Epub 2016 Sep 16.
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.
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.
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).
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.
乙酰胆碱激发试验（ACH 试验）诱发的冠状动脉痉挛（CAS）患者中，血管舒缩类型对长期临床结局的影响尚不清楚。
我们评估了 4644 例连续的有典型静息性胸痛（CP）但无血管造影意义的冠状动脉病变（<50%狭窄）的患者，这些患者均接受了 ACH 试验。根据他们的血管舒缩反应，患者被分为四种类型：正常血管舒缩（无 CP、无缺血性心电图改变和无血管收缩）、微血管痉挛（CP 伴有<75%血管收缩，但在硝酸甘油输注后 CP 缓解）、心外膜痉挛（CP 伴有≥75%血管收缩）和 ACH 试验不确定（血管收缩和/或心电图改变，但无 CP）。我们研究了需要随访血管造影的 CP 复发和 5 年内主要不良心血管事件（MACEs）。
CP 复发率为 7.9%，在异常血管舒缩类型中更为常见（正常血管舒缩、微血管痉挛、心外膜痉挛和不确定类型的 CP 复发率分别为 5.4%、9.8%、10.9%和 8.2%，log-rank p=0.009）。在调整 ACH 试验后药物使用的多变量分析中，血管舒缩亚型不是独立的预测因素，而男性、基线血管造影上的固定病变以及包括钙通道阻滞剂（CCB）、硝酸盐和他汀类药物在内的药物是 CP 复发的独立阳性预测因素。初次访谈时饮酒是 CP 复发的阴性预测因素。MACEs发生率为 1.6%，各亚型之间的发生率相似（p=0.421）。
CP 复发和长期结局与血管舒缩亚型无关，但长期使用 CCB、硝酸盐和他汀类药物是 CP 复发的显著预测因素。
