The 24-Month Prognosis of Patients With Positive or Intermediate Results in the Intracoronary Ergonovine Provocation Test

• Published in: JACC. Cardiovascular interventions Vol. 8; no. 7; pp. 914 - 923
• Main Authors: Shin, Dong IL, MD, Baek, Sang Hong, MD, Her, Sung Ho, MD, Han, Seung Hwan, MD, Ahn, Youngkeun, MD, Park, Keun-Ho, MD, Kim, Dong-Soo, MD, Yang, Tae-Hyun, MD, Choi, Dong-Ju, MD, Suh, Jung-Won, MD, Kwon, Hyuck Moon, MD, Lee, Byoung Kwon, MD, Gwon, Hyeon-Cheol, MD, Rha, Seung-Woon, MD, Jo, Sang-Ho, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-06-2015
• Subjects: Adult; Aged; Angina Pectoris - diagnosis; Angina Pectoris - mortality; Angina Pectoris - physiopathology; Angina Pectoris - therapy; Cardiovascular; Coronary Angiography; Coronary Artery Disease - diagnosis; Coronary Artery Disease - mortality; Coronary Artery Disease - physiopathology; Coronary Artery Disease - therapy; Coronary Vasospasm - diagnosis; Coronary Vasospasm - mortality; Coronary Vasospasm - physiopathology; Coronary Vasospasm - therapy; Coronary Vessels - drug effects; Coronary Vessels - physiopathology; Disease Progression; Disease-Free Survival; ergonovine; Ergonovine - administration & dosage; Female; Humans; Incidence; Kaplan-Meier Estimate; Male; Middle Aged; Predictive Value of Tests; prognosis; Proportional Hazards Models; Prospective Studies; Registries; Republic of Korea - epidemiology; Risk Factors; Smoking - adverse effects; Smoking - mortality; Time Factors; Vasoconstriction - drug effects; Vasoconstrictor Agents - administration & dosage; vasospastic angina; Republic of Korea; CCB; JCSA; VSA; myocardial infarction; ergonovine; CAG; ECG; LCA; prognosis; electrocardiography; Japanese Coronary Spasm Association; left coronary artery; right coronary artery; RCA; vasospastic angina; calcium-channel blocker; MI; coronary angiography
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2014.12.249

Abstract Objectives This study was an observational, multicenter registry to determine clinical characteristics and 24-month prognosis of patients who underwent intracoronary ergonovine provocation tests. Background The clinical characteristics and prognosis of patients who underwent the ergonovine provocation for vasospastic angina were not fully elucidated. Methods A total of 2,129 patients in the VA-KOREA (Vasospastic Angina in Korea) registry were classified into positive (n = 454), intermediate (n = 982), and negative (n = 693) groups by intracoronary ergonovine provocation tests. The 24-month incidences of cardiac death, new-onset arrhythmia, and acute coronary syndrome were determined (mean 26.7 ± 8.8 months). Results The number of smokers, frequency of angina before angiography, high-sensitivity C-reactive protein, and triglyceride were higher in the positive group than in other groups. The clinical characteristics of the intermediate and the negative groups were very similar. In the positive group, the incidences of diffuse, focal, and mixed spasm were 65.9%, 23.6%, and 10.6%. Coronary spasm was more frequently provoked on atherosclerotic segments. The 24-month incidences of cardiac death, arrhythmia, and acute coronary syndrome were low (0.9%, 1.6%, and 1.9%, respectively) in the positive group, and there was no cardiac death in the intermediate group (p = 0.02). In the positive group, frequent angina, current smoking, and multivessel spasm were independent predictors for adverse events. Conclusions The 24-month prognosis of the positive group in the intracoronary ergonovine provocation test was relatively worse than that of the intermediate group. More intensive clinical attention should be paid to vasospastic angina patients with high-risk factors including frequent angina before angiography, current smoking, and multivessel spasm.