Multivessel versus single vessel spasm, as assessed by the intracoronary acetylcholine provocation test, in Korean patients

Abstract

1. Coronary artery spasm (CAS) is known to be a major cause of myocardial ischaemia. Multivessel coronary spasm (MVS) in particular is likely to induce more severe and prolonged myocardial ischaemia than single vessel spasm (SVS). 2. In the present study, a total of 1082 consecutive patients without significant coronary artery disease who underwent an acetylcholine (ACh) provocation test between March 2004 and April 2009 were investigated. Patients were divided into three groups: an MVS group (n = 275), an SVS group (n = 376) and a non-CAS group (n = 431). Differences in clinical and angiographic characteristics following the ACh provocation test were evaluated between the MVS, SVS and non-CAS groups. 3. At baseline, patients in the MVS group had the highest prevalence of peripheral artery disease (PAD), hyperlipidaemia, smoking and old age, as well as the highest triglyceride levels. Calcium channel blockers were most frequently prescribed in MVS patients before the ACh test. During the ACh test, the highest prevalence of chest pain, ischaemic electrocardiogram changes, baseline spasms and diffuse and severe spasms were observed in the MVS group. The response rate to lower ACh doses that induce CAS was also higher in the MVS group. Multivariate analysis showed that the presence of PAD (odds ratio (OR) 2.0; P = 0.006) and baseline spasm (OR 1.4; P = 0.045) were independent predictors of ACh-induced MVS. 4. In conclusion, ischaemic symptoms, diffuse and severe spasm and baseline spasm were more frequently associated with MVS patients, suggesting more intensive medical therapies and close clinical follow up would be required for this patient group.

Angiographic and Clinical Characteristics according to Intracoronary Acetylcholine Dose in Patients with Myocardial Bridge

“…Fourth, according to the guideline for diagnosis and treatment of patients with vasospastic angina (Japanese Circulation Society, 2008), CAS was 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)' [28]. However, we have modified the positive ACh provocation test criteria for patient's safety and efficacy, as published elsewhere [29,30]. We considered the patient's safety, convenience and efficacy in the real world practice because most of patients of this study underwent ACh provocation test on the basis of outpatient clinic via a 4-Fr transradial approach.…”

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

“…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.…”

“…The methods of the Ach provocation test has been described previously 45. In brief, CAG was performed to confirm the presence of significant CAD.…”

“…Multi-vessel spasm was defined with significant CAS of more than two major epicardial arteries. Diffuse CAS was defined as significant CAS with the site length of more than 20 mm 5. Baseline spasm was defined as focal or diffuse narrowing of greater than 30% in baseline CAG, compared to the reference vessel diameter after nitroglycerin administration into intracoronary route.…”

The Impact of High Sensitivity C-Reactive Protein Level on Coronary Artery Spasm as Assessed by Intracoronary Acetylcholine Provocation Test

“…Among them, 2053 patients who had typical or atypical chest pain and had been diagnosed by coronary angiography with insignificant coronary artery disease (CAD), underwent intracoronary ACh provocation test. The exclusion criteria of this study was referenced with previous our studies 3,4. We excluded the patients with one of the following conditions such as prior coronary artery bypass graft, prior percutaneous coronary intervention, prior cerebrovascular disease, advanced heart failure (New York Heart Association class III or IV), or serum creatinine ≥3 mg/dL.…”