Acetylcholine-Provoked Coronary Spasm at Site of Significant Organic Stenosis Predicts Poor Prognosis in Patients With Coronary Vasospastic Angina
Acetylcholine-Provoked Coronary Spasm at Site of Significant Organic Stenosis Predicts Poor Prognosis in Patients With Coronary Vasospastic Angina
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DOI：
10.1016/j.jacc.2015.06.1324
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发表时间：
2015-09-08
影响因子：
24
通讯作者：
Ogawa, Hisao
中科院分区：
文献类型：
--
作者：
Ishii, Masanobu;Kaikita, Koichi;Ogawa, Hisao
背景冠状动脉痉挛是变异型心绞痛和缺血性心脏病的发病机制之一，并可能在动脉粥样硬化的发展过程中起一定作用。目前尚不清楚痉挛的位置是否与预后有关。结论本研究比较了在显著动脉粥样硬化狭窄部位发生冠状动脉痉挛的患者与在无狭窄或非显著狭窄部位发生痉挛的患者的临床特征和预后。877例典型或非典型心绞痛样胸痛患者接受乙酰胆碱（ACh）激发试验。共有1，760名患者符合分析条件。ACh引起的冠状动脉痉挛和显着的器质性狭窄分别观察873和358 patients.Results在显着的动脉粥样硬化性狭窄的患者中，ACh阳性患者（n = 233）与非痉挛患者（n = 125）相比，年轻，无糖尿病。在无器质性狭窄的患者中，ACh阳性患者（n = 640）年龄较大，有血脂异常，比非痉挛患者（n = 762）更可能有缺血性心脏病家族史。多元逻辑回归分析确定心绞痛发作时ST段抬高、左前降支器质性狭窄和多支血管痉挛与器质性狭窄部位痉挛相关（n = 192）。多变量分析确定乙酰胆碱引起的痉挛在网站的显着狭窄和使用硝酸盐作为2个预后因素的主要不良心脏events.Conclusions的临床特征和预后的乙酰胆碱引起的冠状动脉痉挛的患者是不同的，当它发生在网站的显着动脉粥样硬化性狭窄与痉挛患者相比，其他地方。器质性狭窄部位的痉挛和硝酸盐的使用是主要不良心脏事件的重要预测因素。(C)2015年由美国心脏病学会基金会。
BACKGROUND Coronary artery spasm contributes to the pathogenesis of variant angina and ischemic heart disease and may play a role in the progression of atherosclerosis. It is unclear whether the location of spasm is related to outcome.OBJECTIVES This study compared the clinical features and prognosis of patients with coronary spasm at the site of significant atherosclerotic stenosis with patients with spasm at sites without stenosis or nonsignificant stenosis.METHODS This was a retrospective, observational study of 1,877 consecutive patients with typical or atypical angina-like chest pain undergoing acetylcholine (ACh)-provocation testing. A total of 1,760 patients were eligible for analysis. ACh-provoked coronary spasm and significant organic stenosis were observed in 873 and 358 patients, respectively.RESULTS In patients with significant atherosclerotic stenosis, ACh-positive patients (n = 233) were younger and without diabetes mellitus compared with nonspasm patients (n = 125). In patients without organic stenosis, ACh-positive patients (n = 640) were older, had dyslipidemia, and were more likely to have a family history of ischemic heart disease than nonspasm patients (n = 762). Multiple logistic regression analysis identified ST-segment elevation during anginal attacks, organic stenosis of the left anterior descending artery, and multivessel spasm as correlates of spasm at sites of significant organic stenosis (n = 192). Multivariate analysis identified ACh-provoked spasm at the site of significant stenosis and use of nitrates as the 2 prognostic factors for major adverse cardiac events.CONCLUSIONS The clinical features and prognosis of patients with ACh-provoked coronary spasm were different when it occurred at the site of significant atherosclerotic stenosis compared with patients with spasm elsewhere. Both spasm at the site of significant organic stenosis and nitrate use were significant predictors of major adverse cardiac events. (C) 2015 by the American College of Cardiology Foundation.