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

Park, Ji Young; Rha, Seung Woon; Li, Yong Jian; Chen, Kang Yin; Choi, Se Yeon; Ryu, Sung Kee; Choi, Jae Woong; Kim, Tae Kyun; Kim, Jeong‐Min; Bak, Yoon Suk; Lee, Jae Hoon; Im, Sung Il; Kim, Sun Won; 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:10.3349/ymj.2013.54.6.1299

Cited by 10 publications

(9 citation statements)

References 8 publications

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“… 11) Inflammation is a well-known aggravating factor for endothelial dysfunction. Park et al 12) reported that a higher CRP level was associated with a higher incidence of CAS, poorer angiographic characteristics and ischemic ECG change. Takaoka et al 13) reported their findings from Japanese CAS patients with or without organic stenosis.…”

Section: Discussionmentioning

confidence: 99%

Impact of Cigarette Smoking: a 3-Year Clinical Outcome of Vasospastic Angina Patients

et al. 2016

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Background and ObjectivesCigarette smoking is a risk significant factor in coronary artery disease (CAD) and vasospastic angina (VSA). However, it is largely unknown whether smoking adds to any long-term clinical risk in VSA patients.Subjects and MethodsA total of 2797 patients without significant CAD underwent acetylcholine (Ach) provocation test between November 2004 and October 2010. Patients were divided into three groups, based on the presence of coronary artery spasm (CAS) and smoking habits (non-CAS group: n=1188, non-smoking CAS group: n=1214, smoking CAS group: n=395). All CAS patients were prescribed with anti-anginal medications for at least 6 months. The incidence of major clinical outcomes and recurrent angina of these groups were compared up to 3 years.ResultsThere were considerable differences in the baseline clinical and angiographic characteristics among the three groups, but there was no difference in the endpoints among the three groups (including individual and composite hard endpoints) such as death, myocardial infarction, de novo percutaneous coronary intervention, cerebrovascular accident, and major adverse cardiac events. However, there was a higher incidence of recurrent angina in both the non-smoking CAS group and smoking CAS group, as compared to the non-CAS group. In multivariable adjusted Cox-proportional hazards regression analysis, smoking CAS group exhibited a higher incidence of recurrent angina compared with the non-CAS group (hazard ratio [HR]; 2.46, 95% confidence interval [CI]; 1.46-4.14, p=0.001) and non-smoking CAS group (HR; 1.76, 95% CI; 1.08-2.87, p=0.021).ConclusionCigarette smoking CAS group exhibited higher incidence of recurrent angina during the 3-year clinical follow-up compared with both the non-CAS group and non-smoking CAS group. Quitting of smoking, paired with intensive medical therapy and close clinical follow-up, can help to prevent recurrent angina.

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Section: Discussionmentioning

confidence: 99%

Impact of Cigarette Smoking: a 3-Year Clinical Outcome of Vasospastic Angina Patients

et al. 2016

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“…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%

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

Section: Methodsmentioning

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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“…C-reactive protein (CRP) is a marker of chronic inflammation and is associated with the prognosis of various cardiovascular diseases. Several studies have reported that CRP is elevated in patients with VSA and that CRP concentration is useful in VSA diagnosis [ 78 , 79 , 80 ]. Cho et al showed that elevated CRP level was associated with the clinical presentation of ACS in patients with VSA [ 46 ].…”

Section: Factors Associated With Long-term Prognosis Of Vsamentioning

confidence: 99%

Current Evidence on Long-Term Prognostic Factors in Vasospastic Angina

Kim

2021

JCM

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Vasospastic angina (VSA) is characterized by a reversible spasm of the coronary arteries and is more prevalent in Asians. Vasodilators, such as calcium channel blockers, are effective in relieving coronary spasms and preventing clinical events. Therefore, the prognosis of VSA is generally known to be better than for significant organic stenosis caused by atherosclerosis. However, coronary vasospasm is sometimes associated with fatal complications such as sudden death, ventricular arrhythmia, and myocardial infarction. Thus, it is very important to identify and actively treat high-risk patients to prevent VSA complications. Here, we will review clinical factors associated with long-term prognosis in patients with VSA.

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

Cited by 10 publications

References 8 publications

Impact of Cigarette Smoking: a 3-Year Clinical Outcome of Vasospastic Angina Patients

Impact of Cigarette Smoking: a 3-Year Clinical Outcome of Vasospastic Angina Patients

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

Current Evidence on Long-Term Prognostic Factors in Vasospastic Angina

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