Background

Coronary artery spasm (CAS) is known to be a major cause of myocardial ischemia. Multivessel coronary artery spasm (MVS) is likely to induce more severe and prolonged myocardial ischemia than single vessel spasm (SVS). The aim of this study is to evaluate the impact of MVS vs. SVS as assessed by the intracoronary acetylcholine provocation test on 3 years clinical outcomes.

Methods

A total of 2,998 consecutive patients (pts) without significant coronary artery disease who underwent an acetylcholine (Ach) provocation test between November 2004 to October 2010 in Cardiovascular center of Korea University Guro Hospital. Among them, a total of 1,609 pts were finally diagnosed as CAS positive and the patients were divided into two groups such as MVS group (n=555pts) and SVS group (n=1054 pts). To adjust potential confounders, propensity score matched analysis was performed using the logistic regression model (C-statics: 0.81). After propensity score match (PSM), total of 1,068 pts were enrolled for this analysis (MVS: n=534 pts, SVS: n=534 pts).

Results

After PSM, the baseline clinical characteristics and medication were balanced between two groups. During the ACh test, the response rate to lower ACh doses that induce CAS was higher in MVS group. However, there were no difference of cumulative clinical outcomes including mortality, coronary revascularization (CR), cerebrovascular disease (CVD), and repeated percutaneous coronary artery angiography (CAG) due to recurrent chest pain up to 3 years (Table 1). Multivariate analysis showed that MVS was not a predictor of repeated CAG due to recurrent chest pain (OR:1.4, 95% CI: 0.9-2.2, p-value=0.189) and major adverse cardiac events (MACE) including mortality, CR, CVD, and repeated CAG due to recurrent chest pain (OR:1.3, 95% CI: 0.2-6.0, p-value=0.705).

Conclusions

MVS is associated with higher response rate to lower ACh doses that induce CAS. However, MVS was not a predictor of repeated CAG due to recurrent chest pain and MACE as compared with SVS.

Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.