Incidence of Coronary Artery Spasm According to Stratified 10-Year Atherosclerotic Cardiovascular Disease Risk Score in Patients With Chest Pain and Mild-Moderate Coronary Artery Stenosis

초록

BACKGROUND Coronary artery spasm (CAS) is a major cause of variant angina in patients with chest pain without significant coronary stenosis. However, whether there are differences in CAS incidence according to a 10-year atherosclerotic cardiovascular disease (ASCVD) risk score is limited. METHODS A total of 3,800 patients with chest pain with mild to moderate coronary stenosis (30% to 69% diameter stenosis, DS) who underwent 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, n¼1,052), 5.0 % to 9,9% group (AS2, n¼865), 10.0% to 19.9% group (AS3, n¼1,145) and S20% group (AS4, n¼738). RESULTS In the total population, the overall incidence of CAS was 59.7% (2267/3,800). A 10-year ASCVD risk score was well stratified from AS1 to AS4, such as 1.8% in AS1, 7.5% in AS2, 14.1% in AS3, and 31.3% in AS4 (P<0.001). Baseline characteristics also stratified well, presenting worse in AS4 than in AS1. Moderate coronary stenosis (50- 69%) was 7.1% in AS1, 8.4% in AS2, 12.1% in AS3, and 20.1% in AS4 (P<0.001). From AS1 to AS4, the incidence of CAS was slightly increased by 57.3%, 59.8%, 60.2%, and 62.1%, but statistically insignificant (P¼0.232). CONCLUSIONS In patients with chest pain and mild-moderate coronary stenosis, the incidence of CAS was approximately 60% in all the groups and did not stratify with the 10-year ASCVD risk score.