Impact of Baseline Spasm on 3-year Clinical Outcomes in Patient with Significant Coronary Artery Spasm as Assessed by Acetylcholine Provocation Test

초록

Background: It has been not known whether the presence of baseline coronary artery spasm (CAS) can impact on long-term clinical outcomes in patients with significant CAS. Methods: The baseline coronary spasm was defined that the diameter of epicardial coronary artery after nitroglycerin administration can be increased greater than 30% compared to the reference vessel diameter at baseline angiography. The definition of positive Ach provocation test was defined as transient significant coronary vasoconstriction more than 70% following incremental Ach injection into left coronary artery. A total of 1,546 patients (baseline spasm, n=402; control, n=1144) were finally enrolled and compared the cumulative clinical outcomes up to 3 years. Results: Baseline clinical characteristics were balanced between the two groups except current alcoholics. In multivariate binary logistic regression analysis adjusted by multiple co-variates, the presence of baseline spasm was associated with the increased incidence of recurrent chest pain (OR, 1.791; 95% CI, 1.103-2.907). Also, in Kaplan-Meyer curve, the incidence of recurrent chest pain requiring repeat coronary angiography was higher in the baseline spasm group than the control group (log rank test, p=0.017, Figure). Conclusions: In our study, we found that the presence of baseline spasm was associated with increased incidence of recurrent chest pain during 3-year follow-up period. Special caution with intensive medical therapy and close clinical follow up would be required.