ǥ :
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ȣ - 510192 188 |
Different Clinical and Angiographic Characteristics of Focal versus Diffuse Coronary Artery Spasm induced by Acetylcholine Provocation Test |
고려대학교 구로병원 순환기내과 |
나승운, 윤영경, Zhe Jin, Kang-yin Chen, Yoshiyasu Minami, 나진오, 서순용, 최철웅, 김진원, 김응주, 박창규, 서홍석, 오동주 |
Background: The coronary artery spasm (CAS) can be classified as angiographic focal or diffuse type spasm. This study was to investigate whether there are clinical and angiographic differences between focal or diffuse CAS induced by acetylcholine (Ach) provocation test.
Methods: A total 1207 pts (606 men, Age; 58.12±11.14 yrs) without significant coronary lesion underwent Ach provocation test. Ach was injected in incremental doses of 20, 50, and 100μg into left coronary artery. Focal CAS was defined when the length of significant narrowing is less than 20mm.
Results: Significant CAS was documented in 668 pts (55.3 %) and classified as either Focal CAS (n=120) or Diffuse CAS (n=548). Baseline characteristics were similar between the groups. Although the rate of spasm to lower Ach doses (20 ug), Spasm severity and mean % stenosis were not different between groups, there were more chest pain, fixed lesion in the spasm segment and multivessel spasm in the pts with diffuse CAS.
Conclusion: Documented diffuse CAS by Ach provocation test might be translated into more ischemic chest pain, mixed angina and significant multivessel spasm. This result may support that diffuse CAS is more responsible for the decreased vasomotility and coronary flow reserve than focal CAS. Special caution should be exercised for optimal medical management.
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Table.
Clinical and angiographic characteristics
N
(%) |
Focal
spasm (n=120) |
Diffuse
spasm (n=548) |
p
value |
ST-T change in
ECG |
11(9.4) |
63(11.8) |
0.539 |
Chest
pain |
60(50.0) |
356(65.0) |
0.002 |
Myocardial
bridge |
10(8.3) |
29(5.3) |
0.207 |
Fixed
lesion |
33(28.5) |
58(11.2) |
<0.001 |
Multivessel
Spasm |
6(6.6) |
229(48.4) |
<0.001 |
Spasm % stenosis
(%) |
68.61±14.67 |
68.77±14.33 |
0.981 |
Response to Lower
Ach Dose; A1
(20ug) |
10
(8.6) |
37
(6.4) |
0.485 |
Severe
Spasm |
59
(49.6) |
251
(47.1) |
0.981 |
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