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Yang L, Wang K, Yang J, Hu FX. Effects of Smoking on Major Adverse Cardiovascular Events in Patients With Coronary Artery Spasm: A Systematic Review and Meta-Analysis. Heart Lung Circ 2024:S1443-9506(24)00153-7. [PMID: 38816281 DOI: 10.1016/j.hlc.2024.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 01/31/2024] [Accepted: 02/12/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Smoking is an established independent risk factor for coronary artery spasm (CAS), but its effects on major adverse cardiovascular events (MACE) in patients with CAS have not been systematically assessed. METHODS This systematic review and meta-analysis of studies published from January 2000 to July 2023 was conducted to examine the relationship between smoking and MACE in patients with CAS. Data on MACE were obtained from both smoking and non-smoking CAS patient groups. The effects of smoking on MACE in patients with CAS were assessed through meta-analysis, utilising Stata 17.0 software for all statistical analyses. RESULTS Nine studies, encompassing 9,376 patients, from Japan (5 studies), Korea (4 studies) and Spain (1 study) were included in the final analysis. Meta-analysis revealed that smoking significantly impacted MACE in patients with CAS (RR 1.965; 95% CI 1.348-2.865), a finding further validated by sensitivity analyses. Subgroup analyses identified a stronger correlation between smoking and increased MACE endpoints in Japanese patients and in those with >3 years of follow-up. CONCLUSIONS This meta-analysis strongly indicates that smoking escalates the risk of MACE in patients with CAS, with a more pronounced association observed in Japanese patients and those with extended follow-up periods.
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Affiliation(s)
- Lei Yang
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Kun Wang
- Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jie Yang
- Department of Cardiovascular, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China.
| | - Fang-Xiao Hu
- Shandong University of Traditional Chinese Medicine, Jinan, China
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2
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Wu YY, Mao WW, Li YF, Zhang Q, Zhang B, Sheng ZQ. Intra-brachial ergonovine, not acetylcholine, is associated with radial artery vasospasm in patients with coronary vasospasm. Acta Cardiol 2023; 78:135-141. [PMID: 35899777 DOI: 10.1080/00015385.2022.2030552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND The intracoronary provocation test is expensive and may cause complications. Therefore, we investigated the sensitivity, specificity and safety of different drug- and dose-peripheral artery provocation tests in the diagnosis of coronary artery spasm (CAS). METHODS The patients who had repeated chest pain as well as both coronary and radial stenoses <50% were selected. These patients were divided into CAS group (n = 24) and control group (n = 33) after the intracoronary ergonovine provocation test. All patients underwent radial artery provocation tests at different dose-acetylcholine (200 µg, 400 µg and 800 µg) and ergonovine (60 µg, 100 µg and 160 µg). The predictive values of radial provocation tests for CAS diagnosis were analysed using receiver operator characteristic (ROC) curves. RESULTS In radial acetylcholine provocation tests, 200 µg of acetylcholine failed to induce radial artery spasm, and the radial artery stenosis degree was not significantly different between the CAS group and control group at 400 µg and 800 µg of acetylcholine (all p > 0.05). In the radial artery ergonovine provocation tests, the radial artery stenosis degree was all significantly higher in the CAS group than in the control group at the three different doses (all p < 0.05). The specificity and sensitivity of radial ergonovine provocation tests were 90.91% and 50.00% at 60 µg, 96.97% and 66.67% at 100 µg, and 90.91% and 95.83% at 160 µg. Only the radial 160 µg-ergonovine provocation test caused CAS in one case. CONCLUSION The radial acetylcholine provocation test has no diagnostic value for CAS. The radial 160 µg-ergonovine provocation test has higher sensitivity and specificity for CAS diagnosis, but its safety should be paid attention to.
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Affiliation(s)
- Ye-Yu Wu
- The Department of Cardiology, the Second Affiliated Hospital of Nantong University, Nantong, China
| | - Wei-Wei Mao
- The Department of Cardiology, the Second Affiliated Hospital of Nantong University, Nantong, China
| | - Ye-Fei Li
- The Department of Cardiology, the Second Affiliated Hospital of Nantong University, Nantong, China
| | - Qing Zhang
- The Department of Cardiology, the Second Affiliated Hospital of Nantong University, Nantong, China
| | - Bo Zhang
- The Department of Cardiology, the Second Affiliated Hospital of Nantong University, Nantong, China
| | - Zhen-Qiang Sheng
- The Department of Cardiology, the Second Affiliated Hospital of Nantong University, Nantong, China
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3
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Kim HL, Jo SH. Current Evidence on Long-Term Prognostic Factors in Vasospastic Angina. J Clin Med 2021; 10:jcm10184270. [PMID: 34575381 PMCID: PMC8469875 DOI: 10.3390/jcm10184270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/20/2023] Open
Abstract
Vasospastic angina (VSA) is characterized by a reversible spasm of the coronary arteries and is more prevalent in Asians. Vasodilators, such as calcium channel blockers, are effective in relieving coronary spasms and preventing clinical events. Therefore, the prognosis of VSA is generally known to be better than for significant organic stenosis caused by atherosclerosis. However, coronary vasospasm is sometimes associated with fatal complications such as sudden death, ventricular arrhythmia, and myocardial infarction. Thus, it is very important to identify and actively treat high-risk patients to prevent VSA complications. Here, we will review clinical factors associated with long-term prognosis in patients with VSA.
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Affiliation(s)
- Hack-Lyoung Kim
- Division of Cardiology, Department of Internal Medicine, Boramae Medical Center, National University College of Medicine, Seoul 07061, Korea;
| | - Sang-Ho Jo
- Division of Cardiology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, Korea
- Correspondence: or
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Zhang Q, Zhang B, Li YF, Chen L, Zheng KL, Lu HH, Sheng ZQ. Values of Radial Artery Provocation Tests at Different Doses of Ergonovine in the Diagnosis of Coronary Artery Spasm. Int Heart J 2021; 62:734-741. [PMID: 34276008 DOI: 10.1536/ihj.20-735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The intracoronary drug provocation test has been the gold standard for diagnosis of coronary artery spasm (CAS); however, it has been identified with severe complications. In this study, we investigated the sensitivity, specificity, and safety of radial artery provocation test at different doses of ergonovine in the diagnosis of CAS. This study enrolled 57 patients, which were then divided into CAS group (n = 24) and control group (n = 33) after intracoronary ergonovine provocation test. All patients underwent radial artery provocation test at different doses of ergonovine. The predictive values of radial artery provocation test for the diagnosis of CAS were analyzed using receiver operator characteristic curve. In the radial artery provocation test at different doses of ergonovine, radial artery stenosis degree was all found to be significantly higher in the CAS group than in the control group (all P < 0.001). In the control group, significant differences were noted in the radial artery stenosis degree between different doses of ergonovine (all P < 0.05). In the CAS group, the radial artery stenosis degree was significantly higher in 160 μg and 100 μg of ergonovine than in 60 μg of ergonovine (all P < 0.001). The radial artery provocation test at 60 μg and 100 μg of ergonovine did not cause CAS, chest pain, and ECG ischemic changes. In the radial artery provocation test at 160 μg of ergonovine, some patients had CAS, chest pain, and ECG ischemic changes. The specificity and sensitivity of radial artery provocation test were 90.91% and 50.00% at 60 μg of ergonovine, 96.97% and 66.67% at 100 μg of ergonovine, and 90.91% and 95.83% at 160 μg of ergonovine for the diagnosis of CAS. As per our findings, we can conclude that the basic tension of radial artery increases in the CAS group. With the increase of ergonovine doses, its sensitivity and specificity improve, but its safety decreases. We will explore the most optimal dose of ergonovine in future studies.
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Affiliation(s)
- Qing Zhang
- Department of Cardiology, The Second Affiliated Hospital of Nantong University
| | - Bo Zhang
- Department of Cardiology, The Second Affiliated Hospital of Nantong University
| | - Ye-Fei Li
- Department of Cardiology, The Second Affiliated Hospital of Nantong University
| | - Liang Chen
- Department of Cardiology, The Second Affiliated Hospital of Nantong University
| | - Kou-Long Zheng
- Department of Cardiology, The Second Affiliated Hospital of Nantong University
| | - Hui-He Lu
- Department of Cardiology, The Second Affiliated Hospital of Nantong University
| | - Zhen-Qiang Sheng
- Department of Cardiology, The Second Affiliated Hospital of Nantong University
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5
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Diagnosis of coronary artery spasm by ergonovine provocation test of radial artery. Sci Rep 2021; 11:3767. [PMID: 33580141 PMCID: PMC7881123 DOI: 10.1038/s41598-021-83356-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/01/2021] [Indexed: 11/08/2022] Open
Abstract
We investigated the sensitivity, specificity and safety of ergonovine provocation test of radial artery in the diagnosis of coronary artery spasm (CAS). The patients who came to our hospital for chest pain from January to June 2020 as well as had coronary stenosis < 50% and no radial artery stenosis, were enrolled in this study. These patients were divided into CAS group and control group after intracoronary ergonovine provocation test. All patients underwent ergonovine provocation test of radial artery, the inner diameter (D0 and D1) and the peak systolic velocities (PSV0 and PSV1) of the radial artery were measured by ultrasound before and after ergonovine provocation. The predictive value of ergonovine provocation test of radial artery for the diagnosis of CAS was analyzed using receiver operator characteristic (ROC) curve. There were 19 patients in the CAS group and 28 patients in the control group. Low density lipoprotein cholesterol and smoking rate were significantly higher in the CAS group than in the control group (all P < 0.05), but there were no significant differences in other items (P > 0.05) between the two groups. In the ergonovine provocation test of radial artery, degree of radial artery stenosis was significantly higher in the CAS group [41.50% (35.60%, 50.00%)] than in the control group [11.25% (5.15%, 23.00%)] (P = 0.000), but there were no siginificant differences in D0, PSV0 and PSV1 between the two groups (P > 0.05). The area under ROC curve of ergonovine (120 µg) provocation test of radial artery for the diagnosis of CAS was 0.912 with 95%CI: 0.792-0.975, P = 0.001, cut-off of 31%, specificity of 92.86% and sensitivity of 84.21%. The ergonovine (120 µg) provocation test of radial artery did not cause any adverse reactions. We concluded that the ergonovine provocation test of radial artery has high sensitivity, specificity and safety in the diagnosis of CAS.
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Pikkarainen E, Blomster J, Sipilä J, Rautava P, Kytö V. Occurrence and mortality of vasospastic angina pectoris hospitalised patients in Finland: a population-based registry cohort study. BMJ Open 2019; 9:e030768. [PMID: 31685505 PMCID: PMC6858179 DOI: 10.1136/bmjopen-2019-030768] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The occurrence and mortality of vasospastic angina pectoris (VAP) is largely unknown in western countries. Our objective was to clarify the occurrence, gender-distribution and mortality of VAP in Finland using a population-based hospital registry. METHODS We studied consecutive patients aged ≥18 years hospitalized with VAP as the primary cause of admission in Finland during 2004-2014. The data were collected from obligatory nationwide registries. During the study period 1762 admissions were recorded. RESULTS Majority of all VAP patients were male (59.7%) and mean age was 65.7±12.0 years. Annual admission rate for VAP was 2.29/100 000 person-years. Men were in higher risk for VAP than women (admission rate 3.00/100 000 vs 1.68/100 000; RR 1.70; p<0.0001). Gender difference was not modified by age. Likelihood of VAP was highest in population aged 70-84 years. Admission rate for VAP decreased notably during the study period. One-year all-cause mortality was 8.0% and 3-year mortality was 15.5% (cardiac mortality 11.1%). Mortality was associated with increasing age, comorbidity burden and lack of detected coronary artery obstruction, but was similar between genders and during the study period. CONCLUSIONS Men have higher risk for vasospastic angina caused admissions. Likelihood of vasospastic angina admission was highest in aged population. The 3-year all-cause mortality was 15.5%. Mortality was associated with increasing age, comorbidities and non-obstructive VAP diagnosis but was similar between genders.
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Affiliation(s)
| | | | - Jussi Sipilä
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
- Department of Neurology, Turku University Hospital, Turku, Finland
- Department of Neurology, Siun Sote, North Carelia Central Hospital, Joensuu, Finland
| | - Päivi Rautava
- Department of Neurology, Siun Sote, North Carelia Central Hospital, Joensuu, Finland
| | - Ville Kytö
- Heart Centre, Turku University Hospital, Turku, Finland
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Sandau KE, Funk M, Auerbach A, Barsness GW, Blum K, Cvach M, Lampert R, May JL, McDaniel GM, Perez MV, Sendelbach S, Sommargren CE, Wang PJ. Update to Practice Standards for Electrocardiographic Monitoring in Hospital Settings: A Scientific Statement From the American Heart Association. Circulation 2017; 136:e273-e344. [DOI: 10.1161/cir.0000000000000527] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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8
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Taqueti VR, Dorbala S, Wolinsky D, Abbott B, Heller GV, Bateman TM, Mieres JH, Phillips LM, Wenger NK, Shaw LJ. Myocardial perfusion imaging in women for the evaluation of stable ischemic heart disease-state-of-the-evidence and clinical recommendations. J Nucl Cardiol 2017; 24:1402-1426. [PMID: 28585034 PMCID: PMC5942593 DOI: 10.1007/s12350-017-0926-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 05/15/2017] [Indexed: 12/21/2022]
Abstract
This document from the American Society of Nuclear Cardiology represents an updated consensus statement on the evidence base of stress myocardial perfusion imaging (MPI), emphasizing new developments in single-photon emission tomography (SPECT) and positron emission tomography (PET) in the clinical evaluation of women presenting with symptoms of stable ischemic heart disease (SIHD). The clinical evaluation of symptomatic women is challenging due to their varying clinical presentation, clinical risk factor burden, high degree of comorbidity, and increased risk of major ischemic heart disease events. Evidence is substantial that both SPECT and PET MPI effectively risk stratify women with SIHD. The addition of coronary flow reserve (CFR) with PET improves risk detection, including for women with nonobstructive coronary artery disease and coronary microvascular dysfunction. With the advent of PET with computed tomography (CT), multiparametric imaging approaches may enable integration of MPI and CFR with CT visualization of anatomical atherosclerotic plaque to uniquely identify at-risk women. Radiation dose-reduction strategies, including the use of ultra-low-dose protocols involving stress-only imaging, solid-state detector SPECT, and PET, should be uniformly applied whenever possible to all women undergoing MPI. Appropriate candidate selection for stress MPI and for post-MPI indications for guideline-directed medical therapy and/or invasive coronary angiography are discussed in this statement. The critical need for randomized and comparative trial data in female patients is also emphasized.
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Affiliation(s)
- Viviany R Taqueti
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, ASBI-L1 037-G, 75 Francis Street, Boston, MA, 02115, USA.
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sharmila Dorbala
- Noninvasive Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, ASBI-L1 037-G, 75 Francis Street, Boston, MA, 02115, USA
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - David Wolinsky
- Department of Cardiovascular Medicine, Cleveland Clinic Florida, Weston, FL, USA
| | - Brian Abbott
- Warren Alpert Medical School, Brown University, Providence, RI, USA
- Cardiovascular Institute, The Miriam and Newport Hospitals, Providence, RI, USA
| | - Gary V Heller
- Gagnon Cardiovascular Center, Morristown Medical Center, Morristown, NJ, USA
| | - Timothy M Bateman
- Saint Luke's Health System, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | - Lawrence M Phillips
- Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York University School of Medicine, New York, NY, USA
| | - Nanette K Wenger
- Division of Cardiology, Department of Medicine, Emory University Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
| | - Leslee J Shaw
- Division of Cardiology, Department of Medicine, Emory University Clinical Cardiovascular Research Institute, Emory University School of Medicine, Atlanta, GA, USA
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9
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Incidence and factors associated with mortality in 2,476 patients with variant angina in Korea. Sci Rep 2017; 7:46031. [PMID: 28383055 PMCID: PMC5382575 DOI: 10.1038/srep46031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 03/08/2017] [Indexed: 12/17/2022] Open
Abstract
This study investigated the incidence and risk factors of mortality in 2,476 patients with variant angina (VA) using the National Health Insurance Service–National Sample Cohort between 2004 and 2011. The risk factors of all-cause and cardiac mortality were investigated using Cox proportional hazards model. Most patients (69.5%) were less than 65 years and 42.9% were women. During the median follow-up duration of 4.9 years, there were 178 (7.2%) and 95 (3.8%) cases of all-cause and cardiac mortality, respectively. Older age, hypertension, diabetes mellitus, poor medication adherence, low household income and tertiary teaching hospitals were independent predictors for all-cause mortality, while older age, hypertension, low household income and tertiary teaching hospitals were independent predictors for cardiac mortality. In conclusion, our findings suggest that traditional risk factor control and continued medication are important to improve VA outcomes, and that household income-level factors should be considered in the assessment of risk of VA patients.
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Choi BG, Rha SW, Park T, Choi SY, Byun JK, Shim MS, Xu S, Li H, Park SH, Park JY, Choi WG, Cho YH, Lee S, Na JO, Choi CU, Lim HE, Kim JW, Kim EJ, Park CG, Seo HS, Oh DJ. Impact of Cigarette Smoking: a 3-Year Clinical Outcome of Vasospastic Angina Patients. Korean Circ J 2016; 46:632-638. [PMID: 27721853 PMCID: PMC5054174 DOI: 10.4070/kcj.2016.46.5.632] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 01/14/2016] [Accepted: 02/16/2016] [Indexed: 11/11/2022] Open
Abstract
Background and Objectives Cigarette smoking is a risk significant factor in coronary artery disease (CAD) and vasospastic angina (VSA). However, it is largely unknown whether smoking adds to any long-term clinical risk in VSA patients. Subjects and Methods A total of 2797 patients without significant CAD underwent acetylcholine (Ach) provocation test between November 2004 and October 2010. Patients were divided into three groups, based on the presence of coronary artery spasm (CAS) and smoking habits (non-CAS group: n=1188, non-smoking CAS group: n=1214, smoking CAS group: n=395). All CAS patients were prescribed with anti-anginal medications for at least 6 months. The incidence of major clinical outcomes and recurrent angina of these groups were compared up to 3 years. Results There were considerable differences in the baseline clinical and angiographic characteristics among the three groups, but there was no difference in the endpoints among the three groups (including individual and composite hard endpoints) such as death, myocardial infarction, de novo percutaneous coronary intervention, cerebrovascular accident, and major adverse cardiac events. However, there was a higher incidence of recurrent angina in both the non-smoking CAS group and smoking CAS group, as compared to the non-CAS group. In multivariable adjusted Cox-proportional hazards regression analysis, smoking CAS group exhibited a higher incidence of recurrent angina compared with the non-CAS group (hazard ratio [HR]; 2.46, 95% confidence interval [CI]; 1.46-4.14, p=0.001) and non-smoking CAS group (HR; 1.76, 95% CI; 1.08-2.87, p=0.021). Conclusion Cigarette smoking CAS group exhibited higher incidence of recurrent angina during the 3-year clinical follow-up compared with both the non-CAS group and non-smoking CAS group. Quitting of smoking, paired with intensive medical therapy and close clinical follow-up, can help to prevent recurrent angina.
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Affiliation(s)
- Byoung Geol Choi
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Taeshik Park
- Department of General Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA
| | - Se Yeon Choi
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Jae Kyeong Byun
- Department of Medicine, Korea University Graduate School, Seoul, Korea
| | - Min Suk Shim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Shaopeng Xu
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Hu Li
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Sang-Ho Park
- Department of Cardiology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Ji Young Park
- Cardiovascular Center, Eulji University, Eulji General Hospital, Seoul, Korea
| | - Woong Gil Choi
- Cardiovascular Center, Chungju Kunkuk University, Chungju, Korea
| | - Yun-Hyeong Cho
- Cardiovascular Center, Seonam University, Myongji Hospital, Goyang, Korea
| | - Sunki Lee
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Hong Euy Lim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jin Won Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dong Joo Oh
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
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de Luna AB, Cygankiewicz I, Baranchuk A, Fiol M, Birnbaum Y, Nikus K, Goldwasser D, Garcia‐Niebla J, Sclarovsky S, Wellens H, Breithardt G. Prinzmetal angina: ECG changes and clinical considerations: a consensus paper. Ann Noninvasive Electrocardiol 2014; 19:442-53. [PMID: 25262663 PMCID: PMC6932094 DOI: 10.1111/anec.12194] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND We will focus our attention in this article in the ECG changes of classical Prinzmetal angina that occur during occlusive proximal coronary spasm usually in patients with normal or noncritical coronary stenosis. RESULTS The most important ECG change during a focal proximal coronary spasm is in around 50% of cases the appearance of peaked and symmetrical T wave that is followed, if the spasm persist, by progressive ST-segment elevation that last for a few minutes, and later progressively resolve. The most frequent ECG changes associated with ST-segment elevation are: (a) increased height of the R wave, (b) coincident S-wave diminution, (c) upsloping TQ in many cases, and (d) alternans of the elevated ST-segment and negative T wave deepness in 20% of cases. The presence of arrhythmias is very frequent during Prinzmetal angina crises, especially ventricular arrhythmias. The prevalence and importance of ventricular arrhythmias were related to: (a) duration of episodes, (b) degree of ST-segment elevation, (c) presence of ST-T wave alternans, and (d) the presence of >25% increase of the R wave. CONCLUSIONS The incidence of Prinzmetal angina is much lower then 50 years ago for many reasons including treatment with calcium channel blocks to treat hypertension and ischemia heart disease and the decrease of smoking habits.
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Affiliation(s)
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Sterling Regional Center for Heart DiseaseMedical University of LodzPoland
| | - Adrian Baranchuk
- Cardiac Electrophysiology and PacingKingston General HospitalQueen's UniversityOntarioCanada
| | - Miquel Fiol
- Coronary Care Unit, IdISPa, Son Espases HospitalPalma de MallorcaSpain
| | - Yochai Birnbaum
- The Section of CardiologyThe Department of MedicineBaylor College of MedicineHoustonTX
| | - Kjell Nikus
- Heart HospitalTampere University Hospital, and University of TampereTampereFinland
| | - Diego Goldwasser
- Santa Creu i Sant Pau HospitalCardiovascular Research CenterCSIC‐ICCCBarcelonaSpain
| | - Javier Garcia‐Niebla
- Sanitary Health Services, E1 HierroValle del Golfo Health CenterCanary IslandsSpain
| | | | - Hein Wellens
- Cardiovascular Research CenterMaastrichThe Netherlands
| | - Günter Breithardt
- Cardiovascular Department (AFNET)Clinical University Institute MünsterMünsterGermany
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12
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Vizzi V, Johnson TW, Jenkins N, Strange JW, Baumbach A. Dynamic separation of coronary artery medial and adventitial layers with vasospasm: New insights using OCT. Int J Cardiol 2013. [DOI: 10.1016/j.ijcard.2012.11.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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13
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Chu G, Zhang G, Zhang Z, Liu S, Wen Q, Sun B. Clinical outcome of coronary stenting in patients with variant angina refractory to medical treatment: a consecutive single-center analysis. Med Princ Pract 2013; 22:583-7. [PMID: 23988479 PMCID: PMC5586808 DOI: 10.1159/000354290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 07/11/2013] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To investigate the efficacy of coronary stenting in patients with variant angina refractory to medical treatment. SUBJECTS AND METHODS Variant angina was diagnosed in 81 patients admitted to the Department of Cardiology between January 2003 and June 2011. However, coronary stenting was performed in 21 patients refractory to medical treatment, but coronary angiography and intravascular ultrasound were performed in all patients, and acetylcholine provocative test was performed in 11 of the 21 patients refractory to medical treatment. Coronary angiography was repeated after 9-12 months in the 21 patients with coronary stents. Clinical follow-up time was 2.5 ± 3.1 years (range 1-8). RESULTS Of the 81 patients, coronary angiography and intravascular ultrasound did not reveal significant stenosis in 13 (16.0%), but revealed 20-75% fixed stenosis in the remaining 68 (84.0%) patients. The acetylcholine provocative test was positive in the 11 patients. Of the 21 patients with coronary stents, the spasm site was located in the right coronary artery in 16 (76.2%) and in the left anterior descending artery in the remaining 5 (23.8%) patients. During the 1- to 8-year follow-up period, 1 of the 21 patients with stents developed recurrent episodes of variant angina, 5 patients had occasional chest pain, and the other 15 were asymptomatic. Coronary angiography at 9-12 months after initial evaluation demonstrated no stenosis in 3 patients, 20-40% in-stent mild intimal hyperplasia in 15 patients, and 50-80% in-stent restenosis in 3 patients. Coronary stenting was performed again in 2 patients. CONCLUSIONS The present study showed that coronary stenting for severe refractory coronary vasospasm was effective and without serious complications. It can be an alternative and viable option for some patients who are refractory to medical therapy and at a high risk of acute coronary syndrome recurrence.
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Affiliation(s)
- Guang Chu
- *Guang Chu, MD, Department of Cardiovascular Medicine, Shanghai Jiaotong University, First People's Hospital, 85 Wu Jin Road, Shanghai 200080 (PR China), E-Mail
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