title: Coronary vasomotor response to intracoronary acetylcholine injection, clinical features, and long-term prognosis in 873 consecutive patients with coronary spasm: analysis of a single-center study over 20 years.
abstract: BACKGROUND
  The aim of this study was to elucidate the correlation between angiographic coronary vasomotor responses to intracoronary acetylcholine (ACh) injection, clinical features, and long-term prognosis in patients with vasospastic angina (VSA).
  
  
  RESULTS
  This is a retrospective, observational, single-center study of 1877 consecutive patients who underwent ACh-provocation test between January 1991 and December 2010. ACh-provoked coronary spasm was observed in 873 of 1637 patients included in the present analysis. ACh-positive patients were more likely to be older male smokers with dyslipidemia, to have a family history of ischemic heart disease, and to have a comorbidity of coronary epicardial stenosis than were ACh-negative patients. ACh-positive patients were divided into 2 groups: those with focal (total or subtotal obstruction, n=511) and those with diffuse (severe diffuse vasoconstriction, n=362) spasm patterns. Multivariable logistic regression analysis identified female sex and low comorbidity of coronary epicardial stenosis to correlate with the ACh-provoked diffuse spasm pattern in patients with VSA. Kaplan-Meier survival curve indicated better 5-year survival rates free from major adverse cardiovascular events in patients with diffuse spasm pattern compared with those with focal spasm pattern (P=0.019). Multivariable Cox hazard regression analysis identified diffuse spasm pattern as a negative predictor of major adverse cardiovascular events in patients with VSA.
  
  
  CONCLUSIONS
  ACh-induced diffuse coronary spasm was frequently observed in female VSA patients free of severe coronary epicardial stenosis and was associated with better prognosis than focal spasm. These results suggest the need to identify the ACh-provoked coronary spasm subtypes in patients with VSA.
authors.affiliation: Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Sato
authors.forename: Koichi
authors.initials: K
authors.lastname: Kaikita
authors.forename: Naoki
authors.initials: N
authors.lastname: Nakayama
authors.forename: Eiji
authors.initials: E
authors.lastname: Horio
authors.forename: Hiromi
authors.initials: H
authors.lastname: Yoshimura
authors.forename: Takamichi
authors.initials: T
authors.lastname: Ono
authors.forename: Keisuke
authors.initials: K
authors.lastname: Ohba
authors.forename: Kenichi
authors.initials: K
authors.lastname: Tsujita
authors.forename: Sunao
authors.initials: S
authors.lastname: Kojima
authors.forename: Shinji
authors.initials: S
authors.lastname: Tayama
authors.forename: Seiji
authors.initials: S
authors.lastname: Hokimoto
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Matsui
authors.forename: Seigo
authors.initials: S
authors.lastname: Sugiyama
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Yamabe
authors.forename: Hisao
authors.initials: H
authors.lastname: Ogawa
mesh_terms: D000109:Acetylcholine / Q000008:administration & dosage; D000368:Aged; D000788:Angina Pectoris, Variant / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000503:physiopathology; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014661:Vasoconstriction / Q000187:drug effects*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D014662:Vasoconstrictor Agents; D000109:Acetylcholine
keywords: acetylcholine‐provocation test; coronary spasm; diffuse spasm; prognosis