Incidence of Coronary Artery Spasm According to the Stratified 10-Year Atherosclerotic Cardiovascular Disease Risk Score in Patients With Chest Pain Without Significant 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 7,059 patients without significant coronary artery disease (CAD, normal to <70% 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% DS of temporary narrowing by ACH or ERG test. Patients were divided into Four groups, based on the ASCVD risk score: <5.0% group (AS1, n¼2,500), 5.0 % to 9,9% group (AS2, n¼1,650), 10.0% to 19.9% group (AS3, n¼1,832) and S20% group (AS4, n¼1,077). RESULTS In the total population, the overall incidence of CAS was 56.5% (3,991/7,059), and mild-moderate coronary stenosis (30%-69%) was 53.8% (3,800/7,059). A 10-year ASCVD risk score was well stratified from AS1 to AS4 by 1.8%, 7.4%, 14.0%, and 30.4%, respectively (P<0.001). Baseline characteristics also stratified well, presenting worse in AS4 than in AS1. From AS1 to AS4, CAS increased by 52.6%, 56.8%, 58.9%, and 61.3% (P<0.001), and mild-moderate coronary stenosis increased by 42.1%, 52.4%, 62.5%, and 68.5%, respectively (P<0.001). In the risk of CAS, compared to AS1, AS2 had an odds ratio (OR) of 1.191 (95% confidence interval [CI]: 1.051 to 1.350, P¼006), AS3 had an OR of 1.293 (95% CI: 1.145 to1.460 P<0.001) and AS4 had an OR of 1.429 (95% CI: 1.235 to1.653, P<0.001). CONCLUSIONS The 10-year ASCVD risk score stratified the CAS incidence in patients with chest pain without significant coronary artery disease (<70% DS), particularly in patients with mild-moderate coronary stenosis.