Diagnostic and Prognostic Role of Nitroglycerin-Induced Dilation in Patients With Suspected Vasospastic Angina Comparison With Ergonovine Provocation Test

초록

Background: In real clinical practice, vasospastic angina (VSA) is frequently assumed by coronary response to nitroglycerin instead of ergonovine provocation test. This study tested the diagnostic and prognostic role of nitroglycerin-induced dilation (NID) in patients with suspected VSA comparison with ergonovine provocation test. Methods: A total of 438 consecutive patients underwent ergonovine provocation test for the diagnosis of VSA. The VSA was defined as coronary artery spasm (>70%) by intracoronary ergonovine injection with chest pain or electrocardiographic change. Positive NID was defined as NID >13.8% increase calculated by receiver-operating characteristic curve analysis. Results: The degree of coronary response to ergonovine showed significant weak inverse correlation with NID (r = −0.315; p < 0.001). Patients with VSA (n = 51) had a significantly greater coronary response to ergonovine (−84.3 ± 10.5% vs. −38.4 ± 17.9%; p < 0.001) and NID (26.3 ± 31.0% vs. 12.5 ± 19.0%; p < 0.001) than did non-VSA patients. Positive NID patients (n = 170) showed a poor accuracy (area under the curve: 0.64; 95% confidence interval: 0.56 to 0.73; p = 0.001; sensitivity 60.4%; specificity 61.3%) for the diagnosis of VSA by ergonovine provocation test. During the mean follow-up period of 22.6 ± 21.4 months, major adverse cardiac events occurred more frequently in the VSA group than non-VSA group (9.6% vs. 2.2%; p = 0.006). According to NID results, the positive NID group had lower major adverse cardiac events rates than the negative NID group did (1.2% vs. 4.3%; p = 0.021). Of interest, the combined positive ergonovine provocation test and negative NID group was associated with poorer prognosis than any other combinations (log rank p < 0.0001). Conclusion: Although NID had a limited role for the detection of VSA defined by ergonovine provocation test, NID provides an additive prognostic role on the clinical outcomes in VSA patients.