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

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

doi:10.1016/j.ijcard.2015.02.021

Cited by 27 publications

(31 citation statements)

References 19 publications

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“…: metoprolol) [9] or non-selective betablockers (i.e. : propranolol) [5] have been reported.To the best of our knowledge, this is first reported coronary spasm triggered by esmolol, and ultra short acting β-1 selective blocker in a late recovery phase.Prognosis of patients with coronary spasm is generally good, showing similar rates of mortality, myocardial infarction and revascularization rates as compared with patients without coronary artery spasm [10]. The mainstream treatments are calcium channel blocker and nitrates although new drugs have been proven useful in selected refractory cases [11].…”

mentioning

confidence: 99%

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Coronary vasospasm after dobutamine stress echocardiogram triggered by esmolol

Martínez¹,

Riquelme²,

Ayala³

et al. 2015

International Journal of Cardiology

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confidence: 99%

“…Prognosis of patients with coronary spasm is generally good, showing similar rates of mortality, myocardial infarction and revascularization rates as compared with patients without coronary artery spasm [10]. The mainstream treatments are calcium channel blocker and nitrates although new drugs have been proven useful in selected refractory cases [11].…”

mentioning

confidence: 99%

Coronary vasospasm after dobutamine stress echocardiogram triggered by esmolol

Martínez¹,

Riquelme²,

Ayala³

et al. 2015

International Journal of Cardiology

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“…Third, East Asian countries, including Korea and Japan, have reported higher incidences of CAS than Western countries by Ach provocation test. Since this registry consists of Korean patients alone, the present results may not be extended to all patients worldwide 17. Fourth, recently, several studies adopted the definition of significant CAS regarding more than 75% narrowing documented by Ach provocation test 181920.…”

Section: Discussionmentioning

confidence: 99%

“…According to guidelines for diagnosis and treatment of patients with vasospastic angina, CAS is defined as transient, total, or sub-total occlusion (>90% stenosis) of a coronary artery with signs/symptoms of myocardial ischemia (angina pain and ischemic ST changes) 21. However, we modified the positive Ach provocation test criteria for patient safety and efficacy, as published elsewhere; and in the present study, significant CAS was defined as focal or diffuse severe transient luminal narrowing (>70%) with or without chest pain or ischemic ECG change, such as ST-T segment elevation, depression (≥1 mm) or T wave inversion 451722. Ach provocation test was performed only on the left coronary artery for patient safety.…”

Section: Discussionmentioning

confidence: 99%

Impact of Diltiazem Alone versus Diltiazem with Nitrate on Five-Year Clinical Outcomes in Patients with Significant Coronary Artery Spasm

Park

Rha

et al. 2017

Yonsei Med J

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PurposeCalcium channel blockers diltiazem and nitrate have been used as selective coronary vasodilators for patients with significant coronary artery spasm (CAS). However, no study has compared the efficacy of diltiazem alone versus diltiazem with nitrate for long-term clinical outcomes in patients with CAS.Materials and MethodsA total of 2741 consecutive patients without significant coronary artery disease with positive CAS by acetylcholine (Ach) provocation test between November 2004 and May 2014 were enrolled. Significant CAS was defined as a narrowing of >70% by incremental intracoronary injection of 20, 50, and 100 µg of Ach into the left coronary artery. Patients were assigned to either the diltiazem group (n=842) or the dual group (diltiazem with nitrate, n=1899) at physician discretion. To adjust for potential confounders, a propensity score matching (PSM) analysis was performed using the logistic regression model. After PSM analysis, two well-balanced groups (811 pairs, n=1622, C-statistic=0.708) were generated.ResultsAt 5 years, there were similar incidences in primary endpoints, including mortality, myocardial infarction, revascularization, and recurrent angina requiring repeat coronary angiography between the two groups. Diltiazem alone was not an independent predictor for major adverse cardiovascular events or recurrent angina requiring repeat coronary angiography.ConclusionDespite the expected improvement of endothelial function and the relief of CAS, the combination of diltiazem and nitrate treatment was not superior to diltiazem alone in reducing mortality and cardiovascular events up to 5 years in patients with significant CAS.

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“…There is no evidence of spasm resolving with time, and anti-anginal management has to be continued for VA patients [15]. In our study, patients diagnosed with VA were treated with nitrates and calcium antagonists to prevent coronary spasm.…”

Section: Risk Factor Of Atrial Fibrillation Developmentmentioning

confidence: 93%