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Comparison of epicardial coronary artery spasm during intracoronary acetylcholine testing between German and Japanese patients with unobstructed coronaries

Session Poster session 1

Speaker Peter Emanuel Ong

Event : ESC Congress 2017

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

Authors : P E Ong (Stuttgart,DE), Y Odaka (Sendai,JP), A Athanasiadis (Stuttgart,DE), A Suda (Sendai,JP), M Komatsu (Sendai,JP), K Nishimiya (Sendai,JP), K Hao (Sendai,JP), R Tsuburaya (Sendai,JP), K Ito (Sendai,JP), H Mahrholdt (Stuttgart,DE), T Schaeufele (Stuttgart,DE), S Hill (Stuttgart,DE), J Takahashi (Sendai,JP), U Sechtem (Stuttgart,DE), H Shimokawa (Sendai,JP)

Authors:
P.E. Ong1 , Y. Odaka2 , A. Athanasiadis1 , A. Suda2 , M. Komatsu2 , K. Nishimiya2 , K. Hao2 , R. Tsuburaya2 , K. Ito2 , H. Mahrholdt1 , T. Schaeufele1 , S. Hill1 , J. Takahashi2 , U. Sechtem1 , H. Shimokawa2 , 1Robert Bosch Hospital - Stuttgart - Germany , 2Tohoku University Hospital, Department of Cardiovascular Medicine - Sendai - Japan ,

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 196

Background: Coronary artery spasm is an established cause for angina pectoris. It has been suggested that there are substantial differences among Asian compared to Caucasian patients with coronary spasm such as prevalence of spasm, gender distribution and angiographic patterns of coronary spasm. However, regular provocative testing for coronary spasm in only rarely performed in Europe or the United States.

Purpose: The aim of this study was to compare German and Japanese patients with unobstructed coronary arteries and proof of epicardial spasm on intracoronary acetylcholine testing (ACh-test).

Methods: Over the period of one year a total number of 178 patients with resting angina and unobstructed coronary arteries with proof of epicardial spasm on intracoronary acetylcholine testing were enrolled in Stuttgart, Germany (n=75, mean age 61±11, 53% female) and Sendai, Japan (n=103, mean age 61±12, 51% female). All patients underwent intracoronary acetylcholine testing according to a standardized protocol. At both institutions the same testing protocol was followed except for the fact that the highest dose of acetylcholine was 200μg in the German patients in the left coronary artery when 100μg did not elicit any spasm. Comprehensive analysis included type of spasm (focal/diffuse), frequency of multivessel spasm and dose of acetylcholine leading to spasm.

Results: Comparison of baseline characteristics and cardiovascular risk factors showed similar age and gender distributions among the two groups. In addition, there was no relevant difference regarding left ventricular ejection fraction (72%±10 vs. 73%±8, p=0.78). The German patients had more hypertension (67% vs. 48%, p=0.014) and were more often found to be active smokers (41% vs. 17%, p=0.001) compared to the Japanese patients. However, comparison of angiographic and ACh-test characteristics revealed that both groups had comparable rates of focal (17% vs. 14%, p=0.40) and diffuse spasm (83% vs. 86%, p=0.40). Moreover, there was a similar frequency of multivessel spasm (29% vs. 36%, p=0.42). On average, spasm was elicited at a higher dose among the German patients (48% of patients at 200μg) compared to the Japanese patients (51% of patients at 100μg).

Conclusion: In contrast to previous studies, German and Japanese patients with resting angina, unobstructed coronary arteries and epicardial spasm on acetylcholine testing share several similarities including comparable types of spasm and comparable rates of multivessel spasm.

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