title: Angiographic and clinical characteristics of patients with acetylcholine-induced coronary vasospasm on follow-up coronary angiography following drug-eluting stent implantation.
abstract: Recent studies have shown that drug-eluting stents (DES) induce vascular endothelial dysfunction in both Cypher and Taxus stents. These studies evaluated coronary vasomotion in the peristent coronary segment for 1 lesion with 1 DES. The angiographic and clinical characteristics of real-world patients with coronary spasm following DES implantation have not been well documented.
  
  
  RESULTS
  All patients at our hospital who underwent coronary angiography at follow up after DES deployment (Cypher and Taxus stents) between July 2007 and March 2009 were included. We performed an acetylcholine (ACh) provocation test for diagnosing coronary vasospasm in 3 vessels, except in patients with significant stenosis or contraindications to ACh administration. ACh provocation test was positive in 36/55 of the coronary arteries (65.4%) and in 30/42 of the patients with DES (71.4%). There was no difference in the positive rate between patients with and without symptoms. A total of 13/20 asymptomatic patients (65.0%) also showed positive results. In patients with positive results in the ACh provocation test, vasoconstriction at segments distal to the stent was exaggerated compared with corresponding segments in non-stented vessels (0.46 ± 0.27 versus 0.31 ± 0.20, respectively; p = 0.008). Vessels with positive results had a longer stent length compared with those with negative results (31.6 ± 13.6 mm versus 24.2 ± 11.2 mm, respectively; p = 0.049).
  
  
  CONCLUSIONS
  Coronary vasoconstriction was exaggerated at distal segments in DES-implanted vessels compared to non-stented vessel segments and stent length was longer in the ACh provocation test positive group.
authors.affiliation: Division of Cardiology, East Medical Center, Higashi Municipal Hospital City of Nagoya, 1-2-23 Wakamizu-cho, Chikusa-ku, Nagoya-shi, Aichi, 464-8547, Japan. sito@higashi-hosp.jp
authors.forename: Shigenori
authors.initials: S
authors.lastname: Ito
authors.forename: Kosuke
authors.initials: K
authors.lastname: Nakasuka
authors.forename: Kotaro
authors.initials: K
authors.lastname: Morimoto
authors.forename: Masahiko
authors.initials: M
authors.lastname: Inomata
authors.forename: Takayuki
authors.initials: T
authors.lastname: Yoshida
authors.forename: Nozomu
authors.initials: N
authors.lastname: Tamai
authors.forename: Shin
authors.initials: S
authors.lastname: Suzuki
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Murakami
authors.forename: Akihiro
authors.initials: A
authors.lastname: Morino
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Koichi
authors.initials: K
authors.lastname: Sato
mesh_terms: D000109:Acetylcholine / Q000009:adverse effects*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D003329:Coronary Vasospasm / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003331:Coronary Vessels / Q000503:physiopathology; D054855:Drug-Eluting Stents / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014661:Vasoconstriction / Q000502:physiology; D014665:Vasodilator Agents / Q000009:adverse effects
chemical_list: D014665:Vasodilator Agents; D000109:Acetylcholine