Abstract 9683: Acetylcholine-Provoked Diffuse Coronary Spasm is Frequently Observed in Female Patients with Coronary Vasospastic Angina Without Severe Coronary Organic Stenosis

Abstract

Coronary Vasospastic angina (VSA) plays an important role in the pathogenesis of ischemic heart disease. However, the relation between angiographic variation of acetylcholine (ACh)-induced coronary spasm and clinical features in VSA patients is not well understood. We analyzed retrospectively angiographic appearance of coronary vasomotor response induced by ACh injection into left coronary artery (LACh) in 1760 consecutive patients who had rest angina-like chest pain between January 1991 and December 2010. Coronary spasm induced by LACh test was defined as a total or subtotal obstruction (focal spasm), or severe diffuse constriction (diffuse spasm) of left epicardial coronary artery associated with transient myocardial ischemia as evidenced by ischemic ST-segment changes on ECG. Of total 1760 patients, 754 (43%) patients were positive for LACh test on the basis of positive criteria (329 diffuse and 425 focal spasm). Patient characteristics were compared between LACh-positive and -negative groups. Rate of smoking, dyslipidemia, family history of ischemic heart disease (IHD), comorbidity of coronary organic stenosis, and myocardial lactate production were significantly higher in LACh-positive than negative groups (49.7% vs. 42.7%, p=0.005, 48.0% vs. 38.1%, p<0.001, 16.2% vs. 9.6%, p<0.001, 26.9% vs. 14.1%, p<0.001, and 60.9% vs. 13.9%, p<0.001, respectively). Next, we analyzed relation between angiographic variation of LACh-provoked coronary spasm and clinical features in VSA patients. Multiple logistic regression analysis revealed that female gender and low comorbidity rate of coronary organic stenosis were significantly associated with diffuse spasm subtype (OR 2.97; 95%CI: 1.90 to 4.66; p<0.001, and OR 0.60; 95%CI: 0.40 to 0.89; p=0.012, respectively). In conclusions, ACh-provoked diffuse coronary spasm was frequently observed in female VSA patients without severe coronary organic stenosis. These results suggested that angiographic subtypes of ACh-provoked coronary spasm might have different clinical features in VSA patients, indicating the necessity of medical treatment suitable for each subtype of the ACh-provoked coronary spasm.