Prognostic Impacts of Comorbid Significant Coronary Stenosis and Coronary Artery Spasm in Patients With Stable Coronary Artery Disease

Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease

Akira Suda¹  Takashi Shiroto¹  Jun Takahashi¹  Yasuharu Matsumoto¹  Satoshi Yasuda¹  Shohei Ikeda¹  Satoshi Miyata¹  Jun Sugisawa¹  Satoshi Tsuchiya¹  Kiyotaka Hao¹  Tomohiko Shindo¹  Ryuji Tsuburaya¹  Koichi Sato¹  Yasuhiko Sakata¹  Hiroaki Shimokawa¹  Kensuke Nishimiya¹  Yoku Kikuchi¹ 

[1] Department of Cardiovascular Medicine Tohoku University Graduate School of Medicine Sendai Japan;

关键词: coronary artery disease;    coronary atherosclerosis;    coronary spasm;    fractional flow reserve;    percutaneous coronary intervention;   

DOI  :  10.1161/JAHA.120.017831

来源: DOAJ

【 摘 要 】

BACKGROUND Stable coronary artery disease is caused by a variable combination of organic coronary stenosis and functional coronary abnormalities, such as coronary artery spasm. Thus, we examined the clinical importance of comorbid significant coronary stenosis and coronary spasm. METHODS AND RESULTS We enrolled 236 consecutive patients with suspected angina who underwent acetylcholine provocation testing for coronary spasm and fractional flow reserve (FFR) measurement. Among them, 175 patients were diagnosed as having vasospastic angina (VSA), whereas the remaining 61 had no VSA (non‐VSA group). The patients with VSA were further divided into the following 3 groups based on angiography and FFR: no organic stenosis (≤50% luminal stenosis; VSA‐alone group, n=110), insignificant stenosis of FFR>0.80 (high‐FFR group, n=36), and significant stenosis of FFR≤0.80 (low‐FFR group, n=29). The incidence of major adverse cardiovascular events, including cardiovascular death, nonfatal myocardial infarction, urgent percutaneous coronary intervention, and hospitalization attributed to unstable angina was evaluated. All patients with VSA received calcium channel blockers, and 28 patients (95%) in the low‐FFR group underwent a planned percutaneous coronary intervention. During a median follow‐up period of 656 days, although the incidence of major adverse cardiovascular events was low and comparable among non‐VSA, VSA‐alone, and high‐FFR groups, the low‐FFR group had an extremely poor prognosis (non‐VSA group, 1.6%; VSA‐alone group, 3.6%; high‐FFR group, 5.6%; low‐FFR group, 27.6%) (P<0.001). Importantly, all 8 patients with major adverse cardiovascular events in the low‐FFR group were appropriately treated with percutaneous coronary intervention and calcium channel blockers. CONCLUSIONS These results indicate that patients with VSA with significant coronary stenosis represent a high‐risk population despite current guideline‐recommended therapies, suggesting the importance of routine coronary functional testing in this population.

【 授权许可】

Unknown