Open AccessClinical Features and Prognosis of Patients With Coronary Spasm–Induced Non– ST ‐Segment Elevation Acute Coronary Syndrome
Author(s) -
Nakayama Naoki,
Kaikita Koichi,
Fukunaga Takashi,
Matsuzawa Yasushi,
Sato Koji,
Horio Eiji,
Yoshimura Hiromi,
Mizobe Michio,
Takashio Seiji,
Tsujita Kenichi,
Kojima Sunao,
Tayama Shinji,
Hokimoto Seiji,
Sakamoto Tomohiro,
Nakao Koichi,
Sugiyama Seigo,
Kimura Kazuo,
Ogawa Hisao
Publication year - 2014
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.114.000795
Subject(s) - medicine , acute coronary syndrome , cardiology , st elevation , elevation (ballistics) , st segment , electrocardiography , myocardial infarction , geometry , mathematics
Background The prevalence, clinical features, and long‐term outcome of patients with non– ST ‐segment elevation acute coronary syndrome ( NSTE ACS ) associated with coronary spasm are not fully investigated. Methods and Results This observational multicenter study enrolled 1601 consecutive patients with suspected NSTE ‐ ACS who underwent cardiac catheterization between January 2001 and December 2010. A culprit lesion was found in 1152 (72%) patients. In patients without a culprit lesion, the acetylcholine provocation test was performed in 221 patients and was positive in 175 patients. In the other patients, coronary spasm was verified in 145 patients during spontaneous attack. Spasm‐induced NSTE ‐ ACS was diagnosed in 320 (20%) patients. Multivariable analysis identified age <70 years (odds ratio [ OR ] 2.19, 95% CI 1.58 to 3.04), estimated glomerular filtration rate >60 mL/min per 1.73 m 2 ( OR 1.72, 95% CI 1.16 to 2.56), and lack of hypertension ( OR 2.55, 95% CI 1.90 to 3.41), dyslipidemia ( OR 2.76, 95% CI 2.05 to 3.73), diabetes mellitus ( OR 2.49, 95% CI 1.78 to 3.48), previous myocardial infarction ( OR 5.37, 95% CI 2.89 to 10.0), and elevated cardiac biomarkers ( OR 2.84, 95% CI 2.11 to 3.83) as significant correlates of spasm‐induced NSTE ‐ ACS ( P <0.01 for all variables). Transient ST ‐segment elevation during spontaneous attack (variant angina) was observed in 119 patients with spasm‐induced NSTE ‐ ACS . Variant angina was more common in nondyslipidemic men among patients with spasm‐induced NSTE ‐ ACS . Conclusions The study showed frequent involvement of coronary spasm in the pathogenesis of NSTE ‐ ACS . Variant angina was observed in one third of patients with spasm‐induced NSTE ‐ ACS . Coronary spasm should be considered even in patients with less coronary risk factors and nonobstructive coronary arteries.