TY - JOUR
T1 - Prognostic impacts of comorbid significant coronary stenosis and coronary artery spasm in patients with stable coronary artery disease
AU - Hao, Kiyotaka
AU - Takahashi, Jun
AU - Kikuchi, Yoku
AU - Suda, Akira
AU - Sato, Koichi
AU - Sugisawa, Jun
AU - Tsuchiya, Satoshi
AU - Shindo, Tomohiko
AU - Nishimiya, Kensuke
AU - Ikeda, Shohei
AU - Tsuburaya, Ryuji
AU - Shiroto, Takashi
AU - Matsumoto, Yasuharu
AU - Miyata, Satoshi
AU - Sakata, Yasuhiko
AU - Yasuda, Satoshi
AU - Shimokawa, Hiroaki
N1 - Funding Information:
This study was supported in part by the grants-in-aid from the Ministry of Education, Culture, Sports, Science, and Technology, Japan.
Funding Information:
Dr. Yasuda has received grants support from Takeda and Abbott and lecture fees from Daiichi Sankyo and Bristol-Myers Squibb. Dr. Shimokawa has received lecture fees from Bayer Yakuhin and Daiichi Sankyo. The remaining authors have no disclosures to report.
Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2021/1/19
Y1 - 2021/1/19
N2 - 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.
AB - 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.
KW - Coronary artery disease
KW - Coronary atherosclerosis
KW - Coronary spasm
KW - Fractional flow reserve
KW - Percutaneous coronary intervention
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U2 - 10.1161/JAHA.120.017831
DO - 10.1161/JAHA.120.017831
M3 - Article
C2 - 33455423
AN - SCOPUS:85100764691
SN - 2047-9980
VL - 10
SP - 1
EP - 13
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 2
M1 - e017831
ER -