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Five-year clinical outcomes in patients with moderate coronary artery spasm as assessed by intracoronary acetylcholine provocation test

Session Poster session 2

Speaker Yong Hoon Kim

Event : ESC Congress 2016

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : Y H Kim (Chuncheon,KR), S-W Rha (Seoul,KP), A-Y Her (Chuncheon,KR), B-G Choi (Seoul,KP), SH Park (Seoul,KP), CU Choi (Seoul,KP), CG Park (Seoul,KP), HS Seo (Seoul,KP), DJ Oh (Seoul,KP), SY Choi (Seoul,KP), JK Byun (Seoul,KP), H Li (Seoul,KP), S-H Park (Cheonan-si,KR), JY Park (Daejeon,KR), JH Ahn (Gumi,KR)

Y.H. Kim1 , S.-W. Rha2 , A.-Y. Her1 , B.-G. Choi2 , S.H. Park2 , C.U. Choi2 , C.G. Park2 , H.S. Seo2 , D.J. Oh2 , S.Y. Choi2 , J.K. Byun2 , H. Li2 , S.-H. Park3 , J.Y. Park4 , J.H. Ahn5 , 1Kangwon National University School of Medicine - Chuncheon - Korea Republic of , 2Korea University Guro Hospital - Seoul - Korea Republic of , 3Soonchunhyang University Hospital - Cheonan - Korea Republic of , 4Eulji University - Seoul - Korea Republic of , 5Soon Chun Hyang University Gumi Hospital - Gumi - Korea Republic of ,

European Heart Journal ( 2016 ) 37 ( Abstract Supplement ), 387-388

Background: Previous studies showed that long-term clinical outcomes of patients (pts) with severe (subtotal or total occlusion) coronary artery spasm (CAS) during acetylcholine (Ach) provocation test were poor. However, there is no available convincing data regarding long-term clinical outcomes of pts with moderate CAS (borderline 50–70% transient narrowing) by Ach provocation test. We compared the 5-year clinical outcomes in pts with moderate CAS compared to severe CAS.

Method: A total 912 consecutive pts without significant coronary artery disease who underwent Ach provocation test between Nov. 2004 and Dec. 2015 were enrolled. Moderate CAS or severe CAS was defined as 50–70% or >70% of narrowing by quantitative coronary angiography with incremental intracoronary injection of 20, 50 and 100ug of Ach infusion. To adjust potential confounders, a propensity score- matched (PSM) analysis was performed using logistic regression model.

Results: After PSM analysis, 2 propensity-matched groups (356 pairs, n=712, C-statistic = 0.653) were generated. The 5-year cumulative incidences of cardiac death (0.8% vs 1.1%), percutaneous coronary intervention (1% vs 1%), myocardial infarction (1.1% vs 0.8%) and cerebrovascular accidents (1.1% vs 0.8%) were not significantly different between 2 groups (Table).

Conclusion: In our study, individual and composite major clinical outcomes were similar between the moderate CAS pts and severe CAS pts up to 5 years.

Clinical outcomes upto 5 years
Variables N (%) Propensity score-matched patients
TotalModerate (n=356)Severe (n=356)p-value
Outcomes at 5-year follow-up
 Cardiac death7 (1.0)3 (0.8)4 (1.1)0.809
 Percutaneous coronary intervention14 (2.0)7 (1.0)7 (1.0)NS
 Myocardial infarction7 (1.0)4 (1.1)3 (0.8)0.809
 Cerebrovascular accidents7 (1.0)4 (1.1)3 (0.8)0.809
Cumulative clinical outcomes up to 5 years.

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