Ten-Year Clinical Outcomes According to Atherosclerotic Cardiovascular Disease Risk Score From AHA/ACC in Korean Patients With Significant Coronary Artery Spasm

초록

Background Atherosclerotic cardiovascular disease (ASCVD) risk score is a well-known risk stratification tool for assessing cardiovascular events. However, validation studies of 10-year ASCVD risk score predicting clinical outcomes in Korean patients, especially in vasospastic angina are limited. Methods A total of 3,991 patients with vasospastic angina, documented by the acetylcholine (ACH) or ergonovine (ERG) provocation test. Patients were divided into four groups, based on the ASCVD risk score: <5.0% group (AS1, n=1,315), 5.0 % to 9,9% group (AS2, n=937), 10.0% to 19.9% group (AS3, n=1,079) and ≧20% group (AS4, n=660). The primary endpoint was major adverse cerebral and cardiovascular event 1 (MACCE 1), including stroke and major adverse cardiovascular event (MACE). The secondary endpoint was MACCE 2, defined as composite of MACE and recurrent angina requiring follow-up coronary angiography (CAG). Results 10-year ASCVD risk score was well stratified from AS1 to AS4 by 1.9%, 7.4%, 14.0%, and 30.5%, respectively (P<0.001). Baseline characteristics were also well stratified, presenting worse clinical profile in AS4 than in AS1. From AS1 to AS4, increasing severity of insignificant coronary stenosis (<70%) (AS1: 45.9%, AS2: 55.2%, AS3: 63.9%, AS4: 69.4%, P<0.001) was observed. Increasing incidence of both MACCE1 and MACCE2 was demonstrated through AS1 to AS4 (MACCE1: 6.6%, 6.9%, 9.6%, 17.6%, P<0.001; MACCE2: 25.3%, 25.2%, 27.8% 36.6%, P<0.001) including stroke (3.8%, 4.3%, 7.5%, 9.5%, P<0.001) and recurrent angina (21.7%, 21.7%, 22.1%, 28.5%, P=0.022). Conclusion The 10-year ASCVD risk score, in addition to stratifying severity of insignificant coronary stenosis, was associated with higher risk of MACCE1 and MACCE2 in patients with significant CAS.