Abstract
Vasospastic angina (VA) is a functional disease of the coronary artery and occurs in an angiographically normal coronary artery. However, it may also occur with coronary artery stenosis. We investigated the effect of coronary artery stenosis on clinical outcomes in VA patients. Study data were obtained from a prospective multicenter registry that included patients who had symptoms of VA. Patients were classified into two groups according to presence of significant coronary artery stenosis. Among 1920 patients with VA, 189 patients were classified in the “significant stenosis” group. The one-year composite clinical events rate was significantly higher in the significant stenosis group than in the “no significant stenosis” group (5.8% vs. 1.4%, respectively; p < 0.001). Additionally, the prevalence of ACS was significantly greater in the “significant stenosis” group (4.8% vs. 0.9%, respectively; p < 0.001). After propensity score matching, the adverse effects of significant stenosis remained. In addition, significant stenosis was independently associated with a 6.67-fold increased risk of ACS in VA patients. In conclusion, significant coronary artery stenosis can increase the adverse clinical outcomes in VA patients at long-term follow-up. Clinicians should manage traditional risk factors associated with atherosclerosis and control vasospasm as well as reduce the burden of atherosclerosis.
Highlights
Vasospastic angina (VA) is caused by focal or diffuse spasm of an epicardial coronary artery, resulting in severe obstruction of the coronary artery lumen and myocardial ischemia [1]
There were no significant differences in other histories or medications related to traditional cardiovascular risk factors or diseases between the two groups
The tendency of coronary artery spasm may be the only cause of functional coronary artery abnormalities, it overlaps with significant coronary artery stenosis
Summary
Vasospastic angina (VA) is caused by focal or diffuse spasm of an epicardial coronary artery, resulting in severe obstruction of the coronary artery lumen and myocardial ischemia [1]. Vasospasm can occur in an angiographically normal coronary artery, but may occur at the site of an existing organic atherosclerotic stenosis [2]. Considering that acute coronary syndrome (ACS) is almost always caused by luminal thrombus or sudden plaque rupture applied to organic atherosclerotic plaques [5], coronary vasospasm can induce the rupture of a stable atheroma, which could lead to myocardial infarction and sudden cardiac death. Previous small studies have shown that significant coronary artery atherosclerotic stenosis is associated with a worse clinical outcome in patients with VA [7,8,9]. There was no significant difference in prognosis of VA patients with or without significant stenosis [10]
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