Background

Coronary artery spasm (CAS) is a major cause of myocardial ischemia. However, long-term clinical outcomes of CAS are unknown. We investigated predictors of recurrent chest pain in patients (pts) with vasospastic angina.

Methods

A total of 2,797 consecutive pts without significant coronary artery disease who underwent Acetylcholine (Ach) test were enrolled.

Results

Ach test revealed 1,609 (57.5%) CAS positive pts [male; n=823 (51.1%), age; 55.0 (interquartile, 47.5-63.2)]. Baseline characteristics included hypertension [n= 663 (41.2%)], diabetes [n=193 (11.9%)], dyslipidemia [n=241 (14.9%)], current smokers [n=395 (24.5%)] and current alcoholics [n=556 (34.5%)]. Ach provocation test showed the incidence of myocardial bridge [n=434 (26.9%)], baseline CAS [n= 495 (30.7%)], diffuse CAS [n= 1344 (83.5%)] and multi-vessel spasm [n= 555 (34.4%)]. After 3 years, recurrent chest pain [n=102 (6.3%)] was the most common event. Other events included all-cause death [n=3 (0.1%)], cardiac death [n=2 (0.1%)], myocardial infarction [n=3 (0.1%)], percutaneous coronary intervention [n=3 (0.1%)] and cerebrovascular accidents [n=3 (0.1%)]. Multivariate analysis showed dyslipidemia (OR; 1.75, 95% C.I; 1.07-2.85, p=0.025) and baseline CAS (OR; 1.91, 95% C.I; 1.26-2.88, p=0.002) to be strong independent predictors of recurrent chest pain (Table).

Conclusion

Therefore pts who have dyslipidemia or baseline CAS should receive intensive anti-anginal management and close clinical follow up.

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