TY - JOUR
T1 - Clinical implications of provocation tests for coronary artery spasm
T2 - Safety, arrhythmic complications, and prognostic impact: Multicentre registry study of the japanese coronary spasm association
AU - Takagi, Yusuke
AU - Yasuda, Satoshi
AU - Takahashi, Jun
AU - Tsunoda, Ryusuke
AU - Ogata, Yasuhiro
AU - Seki, Atsushi
AU - Sumiyoshi, Tetsuya
AU - Matsui, Motoyuki
AU - Goto, Toshikazu
AU - Tanabe, Yasuhiko
AU - Sueda, Shozo
AU - Sato, Toshiaki
AU - Ogawa, Satoshi
AU - Kubo, Norifumi
AU - Momomura, Shinichi
AU - Ogawa, Hisao
AU - Shimokawa, Hiroaki
N1 - Funding Information:
This work was supported by the Japan Heart Foundation, Tokyo, Japan.
PY - 2013/1/21
Y1 - 2013/1/21
N2 - Aims Provocation tests of coronary artery spasm are useful for the diagnosis of vasospastic angina (VSA). However, these tests are thought to have a potential risk of arrhythmic complications, including ventricular tachycardia (VT), ventricular fibrillation (VF), and brady-arrhythmias.We aimed to elucidate the safety and the clinical implications of the spasm provocation tests in the nationwide multicentre registry study by the Japanese Coronary Spasm Association. Methods and results A total of 1244 VSA patients (M/F, 938/306; median 66 years) who underwent the spasm provocation tests were enrolled from 47 institutes. The primary endpoint was defined as major adverse cardiac events (MACEs). The provocation tests were performed with either acetylcholine (ACh, 57%) or ergonovine (40%). During the provocation tests, VT/VF and brady-arrhythmias developed at a rate of 3.2 and 2.7%, respectively. Overall incidence of arrhythmic complications was 6.8%, a comparable incidence of those during spontaneous angina attack (7.0%). Multivariable logistic regression analysis demonstrated that diffuse right coronary artery spasm (P , 0.01) and the use of ACh (P , 0.05) had a significant correlation with provocation-related VT/VF. During the median follow-up of 32 months, 69 patients (5.5%) reached the primary endpoint. The multivariable Cox proportional hazard model revealed that mixed (focal plus diffuse) type multivessel spasm had an important association with MACEs (adjusted hazard ratio, 2.84; 95% confidence interval, 1.34-6.03; P , 0.01), whereas provocation-related arrhythmias did not. Conclusion The spasm provocation tests have an acceptable level of safety and the evaluation of spasm type may provide useful information for the risk prediction of VSA patients.
AB - Aims Provocation tests of coronary artery spasm are useful for the diagnosis of vasospastic angina (VSA). However, these tests are thought to have a potential risk of arrhythmic complications, including ventricular tachycardia (VT), ventricular fibrillation (VF), and brady-arrhythmias.We aimed to elucidate the safety and the clinical implications of the spasm provocation tests in the nationwide multicentre registry study by the Japanese Coronary Spasm Association. Methods and results A total of 1244 VSA patients (M/F, 938/306; median 66 years) who underwent the spasm provocation tests were enrolled from 47 institutes. The primary endpoint was defined as major adverse cardiac events (MACEs). The provocation tests were performed with either acetylcholine (ACh, 57%) or ergonovine (40%). During the provocation tests, VT/VF and brady-arrhythmias developed at a rate of 3.2 and 2.7%, respectively. Overall incidence of arrhythmic complications was 6.8%, a comparable incidence of those during spontaneous angina attack (7.0%). Multivariable logistic regression analysis demonstrated that diffuse right coronary artery spasm (P , 0.01) and the use of ACh (P , 0.05) had a significant correlation with provocation-related VT/VF. During the median follow-up of 32 months, 69 patients (5.5%) reached the primary endpoint. The multivariable Cox proportional hazard model revealed that mixed (focal plus diffuse) type multivessel spasm had an important association with MACEs (adjusted hazard ratio, 2.84; 95% confidence interval, 1.34-6.03; P , 0.01), whereas provocation-related arrhythmias did not. Conclusion The spasm provocation tests have an acceptable level of safety and the evaluation of spasm type may provide useful information for the risk prediction of VSA patients.
KW - Arrhythmia
KW - Prognosis
KW - Vasospastic angina
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U2 - 10.1093/eurheartj/ehs199
DO - 10.1093/eurheartj/ehs199
M3 - Article
C2 - 22782943
AN - SCOPUS:84874598391
VL - 34
SP - 258
EP - 267
JO - European Heart Journal
JF - European Heart Journal
SN - 0195-668X
IS - 4
ER -