Impact of Coronary Artery Spasm on Five-year Clinical Outcomes; a Propensity Score Matched Analysis

초록

Background: There has been limited data regarding long-term clinical outcomes of patients (pts) who has significant coronary artery spasm (CAS) documented by acetylcholine (Ach) provocation test. Methods: A total 1118 patients (pts) underwent coronary angiography with Ach provocation test from Nov 2004 to Oct 2010 were enrolled. 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. After propensity score matching (PSM), total 842 pts (421 pairs with/without CAS) were enrolled and compared cumulative clinical outcomes up to 5 years. Results: After PSM, baseline characteristics were balanced between the two groups. There was no difference in mortality, cardiac death, myocardial infarction between the two groups except the incidence of recurrent chest pain requiring repeat coronary angiography was higher in the positive CAS group (p=0.003, Table). Also, in proportional hazard cox-regression analysis adjusted by multiple significant co-variates, positive CAS was associated with the increased incidence of recurrent chest pain (HR, 1.7; 95% CI, 1.012-2.612; p=0.022). Conclusions: In our study, pts with significant CAS documented by intracoronary Ach provocation test was not associated with increased risk of mortality, cardiac death, and myocardial infarction except recurrent chest pain as compared with pts without CAS during 5-year clinical follow-up.