Ten-Year Clinical Outcomes According to Atherosclerotic Cardiovascular Disease ( ASCVD) Risk Score From AHA/ACC in Chest Pain Patients Without 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 are limited. METHODS A total of 3,068 chest pain patients without coronary artery spasm (CAS), evaluated by the acetylcholine (ACH) or ergonovine (ERG) provocation test between January 2004 and December 2021 were enrolled. Significant CAS was defined as having 70% of temporary narrowing by ACH or ERG test. Patients were divided into four groups, based on the ASCVD risk score: <5.0% group (AS1, n¼1,185), 5.0 % to 9,9% group (AS2, n¼713), 10.0% to 19.9% group (AS3, n¼753) and S20% group (AS4, n¼417). 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 1.8%, 7.4%, 14.1%, and 30.4%, respectively (P<0.001). Baseline characteristics were also well stratified, presenting worse clinical profile in AS4 than in AS1. From AS1 to AS4, the severity of insignificant coronary stenosis (<70%) was increased (AS1: 37.9%, AS2: 48.8%, AS3: 60.6%, AS4: 67.1%, P<0.001). Increasing risk of both MACCE1 and MACCE2 was demonstrated through AS1 to AS4 (MACCE1: 7.1%, 8.0%, 12.9%, 15.7%, P<0.001; MACCE2: 19.3%, 24.7%, 26.4% 30.5%, P<0.001) including MACE (2.2%, 2.3%, 3.8%, 8.5%, P<0.001). CONCLUSIONS The 10-year ASCVD risk score, in addition to stratifying the severity of insignificant coronary artery stenosis, was associated with higher risk of MACCE1 and MACCE2 in patients with chest pain without CAS.