title: A comparison of clinical features of coronary artery spasm with and without thyrotoxicosis.
abstract: OBJECTIVE
  Several reports have suggested that thyrotoxicosis may induce severe coronary artery spasm (CAS). However, there are few data regarding the differences in clinical characteristics of CAS with and without thyrotoxicosis. The aim of our study is to compare the clinical features of CAS with and without thyrotoxicosis.
  
  
  METHODS
  We evaluated 430 consecutive patients with CAS [patients with thyrotoxicosis (N=32, group I) and those without (N=398, group II)] at a single institute between January 2001 and June 2011. We compared clinical presentations, angiographic findings, and adverse outcomes (a composite outcome of cardiac death, myocardial infarction, or rehospitalization due to cardiac cause) of both groups.
  
  
  RESULTS
  There was higher incidence of acute myocardial infarction at initial presentation in group I (15.6 vs. 5.8%, P=0.04). CAS with thyrotoxicosis was more diffuse (59.4 vs. 39.3%, P=0.03), more medically intractable (9.4 vs. 0%, P=0.001), and more frequently involved the left main vessel (25.0 vs.0.8%, P=0.001) than CAS without thyrotoxicosis. During the follow-up period (median 43 months), there were no significant differences between the two groups in terms of the risk of adverse outcomes (hazard ratio for CAS with thyrotoxicosis, 1.029; 95% confidence interval, 0.347-3.054).
  
  
  CONCLUSIONS
  Clinical and angiographic presentations of CAS with thyrotoxicosis were more severe than CAS without thyrotoxicosis, but clinical outcomes were similar in both groups. Optimal vasodilator therapy is essential for the management of CAS with thyrotoxicosis. Thyroid function test should be mandatory for all patients with CAS.
authors.affiliation: Department of Internal Medicine, Division of Cardiology, Sejong General Hospital, Bucheon, Republic of Korea.
authors.forename: Soo Youn
authors.initials: SY
authors.lastname: Lee
authors.forename: Cheol Woong
authors.initials: CW
authors.lastname: Yu
authors.forename: Young Jin
authors.initials: YJ
authors.lastname: Choi
authors.forename: Rak Kyeong
authors.initials: RK
authors.lastname: Choi
authors.forename: Jin Sik
authors.initials: JS
authors.lastname: Park
authors.forename: Hyun Jong
authors.initials: HJ
authors.lastname: Lee
authors.forename: Je Sang
authors.initials: JS
authors.lastname: Kim
authors.forename: Ho Jun
authors.initials: HJ
authors.lastname: Jang
authors.forename: Duck Hyun
authors.initials: DH
authors.lastname: Jang
authors.forename: Myung Joon
authors.initials: MJ
authors.lastname: Chae
authors.forename: Won Heum
authors.initials: WH
authors.lastname: Shim
authors.forename: Young Moo
authors.initials: YM
authors.lastname: Ro
mesh_terms: D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D010359:Patient Readmission; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013971:Thyrotoxicosis / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D013997:Time Factors; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents