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Original research
Percutaneous coronary intervention in patients with documented coronary vasospasm during long-term follow-up
  1. Ju Hyeon Kim1,
  2. Jinoh Park2,
  3. Yujin Yang3,
  4. Sahmin Lee3,
  5. Dae-Hee Kim3,
  6. Jong-Min Song3,
  7. Duk-Hyun Kang3,
  8. Seong-Wook Park3,
  9. Seung-Jung Park3,
  10. Jae-Kwan Song3
  1. 1Department of Cardiology, Cardiovascular Center, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
  2. 2Division of Cardiology, Department of Internal Medicine, Haeundae Paik Hospital, University of Inje College of Medicine, Busan, Republic of Korea
  3. 3Division of Cardiology, Department of Internal Medicine, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea
  1. Correspondence to Dr Jae-Kwan Song, Division of Cardiology, Department of Internal Medicine, Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, Republic of Korea; jksong{at}amc.seoul.kr

Abstract

Objective Although recurring coronary artery spasm (CAS) may lead to the development of fixed atherosclerotic coronary stenosis (FS), the relationship between coronary atherosclerosis and CAS is still speculative. We evaluated the incidence of FS requiring percutaneous coronary intervention (PCI) in patients with documented CAS during long-term follow-up and analysed their clinical features.

Methods Clinical data of 3556 patients during a median follow-up of 9.4 years after non-invasive ergonovine spasm provocation testing with echocardiographic monitoring of left ventricular wall motion (erg echo) were analysed.

Results Erg echo documented CAS in 830 (23.3%) patients, who had higher frequencies of coronary risk factors than those without CAS. Patients with documented CAS on erg echo showed significantly lower 10-year overall (90.5% vs 94.2%, p<0.001) and PCI-free (97.4% vs 98.4%, p=0.002) survival rates than those without CAS. Documented CAS was an independent factor associated with later PCI after adjustment by either Cox regression model or Fine-Gray competing risk model. There was no significant difference in baseline clinical characteristics between patients who needed later PCI and those who did not. Among 28 patients who needed later PCI after documentation of CAS, the original CAS and later PCI territory were concordant in 25 (89.3%), while 3 (10.7%) showed discordance.

Conclusions CAS is a risk factor for the development of FS requiring PCI during long-term follow-up, and warrants physicians’ vigilance and careful follow-up of patients with documented CAS and insignificant stenosis of major epicardial coronary arteries at the time of initial diagnosis.

  • percutaneous coronary intervention
  • angina pectoris
  • coronary stenosis

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors JHK, JP and YY participated in the study design and analysis and interpretation of the final data, as well as in the drafting and approval of the final manuscript. SL, D-HK, J-MS, S-WP, D-HK and S-JP were involved in the recruitment of participants from clinics. J-KS was the guarantor and responsible for the design and supervision of the study and revision of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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