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ȣ - 510188 182 |
Multi-vessel versus Single-Vessel Spasm induced by Intracoronary Acetylcholine Provocation Test |
고려대학교 구로병원 순환기내과 |
Zhe Jin, 나승운, Kang-yin Chen, Yoshiyasu Minami, 나진오, 서순용, 최철웅, 김진원, 김응주, 박창규, 서홍석, 오동주 |
Background: Coronary artery spasm is known to be an important cause of myocardial ischemia. Compared with single-vessel spasm, multi-vessel spasm may induce more severe and prolonged myocardial ischemia. We assessed whether there are different angiographic and clinical characteristics between the multi-vessel spasm and single-vessel spasm induced by intracoronary acetylcholine (Ach) provocation test.
Methods: Study population consisted of 1,207 patients (pts, male 56.4%, age 57.7±11.1 years) who underwent coronary angiography with intracoronary Ach provocation test between Nov 2004 and Feb 2007. A total of 480 pts (39.8%) showed significant Ach-induced endothelial dysfunction. Clinical and angiographic parameters of multi-vessel spasm group (n=191, 39.8%) were compared with those of single-vessel spasm group (n=289, 60.2%).
Results: Baseline characteristics were similar between two groups. Multi-vessel spasm group showed more typical chest pain and ST-T EKG changes during the Ach provocation test. Multi-vessel spasm group showed more vulnerable response to the lower Ach dose (20 to 50 µg). In addition, diffuse and severe spasms were more frequent in multi-vessel spasm group.
Conclusion: Multi-vessel spasm group showed higher frequency of typical chest pain, ECG change during the intracoronary Ach provocation test and showed enhanced vasoconstriction response to lower Ach dose and diffuse, severe coronary spasm compared with single-vessel spasm group.
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Table. Provocation test results
Variables |
Multi-vessel
spasm group
(n=191) |
Single-vessel
spasm group
(n=289) |
P
value |
Significant
response to Ach dose |
|
|
<0.001 |
lower
dose (20, 50 μg) |
49.7 |
35.4 |
higher
dose (100 μg) |
50.3 |
64.5 |
Typical
chest pain(%) |
76.4 |
57.8 |
<0.001 |
ST-T
change in EKG (%) |
16.0 |
7.4 |
0.004 |
Diffuse
spasm(%) |
96.8 |
72.5 |
<0.001 |
Diameter stenosis after Ach infusion(%)
|
71.79±14.70 |
67.45±13.52 |
0.001 |
Diameter stenosis after NTG
infusion(%) |
30.18±9.37 |
30.43±9.18 |
0.920 |
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