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Nakayama N, Kaikita K, Fukunaga T, Matsuzawa Y, Sato K, Horio E, Yoshimura H, Mizobe M, Takashio S, Tsujita K, Kojima S, Tayama S, Hokimoto S, Sakamoto T, Nakao K, Sugiyama S, Kimura K, Ogawa H. Clinical features and prognosis of patients with coronary spasm-induced non-ST-segment elevation acute coronary syndrome. J Am Heart Assoc 2014; 3:e000795. [PMID: 24811613 PMCID: PMC4309067 DOI: 10.1161/jaha.114.000795] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/05/2014] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Naoki Nakayama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (N.N., K.K., K.S., E.H., H.Y., M.M., S.T., K.T., S.K., S.T., S.H., S.S., H.O.)
| | - Koichi Kaikita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (N.N., K.K., K.S., E.H., H.Y., M.M., S.T., K.T., S.K., S.T., S.H., S.S., H.O.)
| | - Takashi Fukunaga
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (T.F., T.S., K.N.)
| | - Yasushi Matsuzawa
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan (Y.M., K.K.)
| | - Koji Sato
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (N.N., K.K., K.S., E.H., H.Y., M.M., S.T., K.T., S.K., S.T., S.H., S.S., H.O.)
| | - Eiji Horio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (N.N., K.K., K.S., E.H., H.Y., M.M., S.T., K.T., S.K., S.T., S.H., S.S., H.O.)
| | - Hiromi Yoshimura
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (N.N., K.K., K.S., E.H., H.Y., M.M., S.T., K.T., S.K., S.T., S.H., S.S., H.O.)
| | - Michio Mizobe
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (N.N., K.K., K.S., E.H., H.Y., M.M., S.T., K.T., S.K., S.T., S.H., S.S., H.O.)
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (N.N., K.K., K.S., E.H., H.Y., M.M., S.T., K.T., S.K., S.T., S.H., S.S., H.O.)
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (N.N., K.K., K.S., E.H., H.Y., M.M., S.T., K.T., S.K., S.T., S.H., S.S., H.O.)
| | - Sunao Kojima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (N.N., K.K., K.S., E.H., H.Y., M.M., S.T., K.T., S.K., S.T., S.H., S.S., H.O.)
| | - Shinji Tayama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (N.N., K.K., K.S., E.H., H.Y., M.M., S.T., K.T., S.K., S.T., S.H., S.S., H.O.)
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (N.N., K.K., K.S., E.H., H.Y., M.M., S.T., K.T., S.K., S.T., S.H., S.S., H.O.)
| | - Tomohiro Sakamoto
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (T.F., T.S., K.N.)
| | - Koichi Nakao
- Division of Cardiology, Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan (T.F., T.S., K.N.)
| | - Seigo Sugiyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (N.N., K.K., K.S., E.H., H.Y., M.M., S.T., K.T., S.K., S.T., S.H., S.S., H.O.)
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan (Y.M., K.K.)
| | - Hisao Ogawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan (N.N., K.K., K.S., E.H., H.Y., M.M., S.T., K.T., S.K., S.T., S.H., S.S., H.O.)
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