P177The clinical, angiographic characteristics and the 24-month prognosis of Korean patients with vasospastic angina

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Abstract

Background: Vasospastic angina (VA) has been reported to be more frequent in the East than in the West. However, in Korea, a grand scale analysis has not been done yet. We planned to set the multi-center registry for Korean VA.

Methods: Total 11 centers of 9 universities participated in prospective, web-based VA-KOREA (Vasospastic Angina in KOREA) registry and the enrollment of patients newly diagnosed as VA using same diagnostic protocol started in July 2010. We only used intracoronary ergonovine, not acetylcholine, in provocation. Positive result of the provocation is defined as development of total or subtotal occlusion accompanied by angina and/or ECG changes. We got information about medical history, laboratory and angiographic findings, treatment, and prognosis. In this analysis, we determined the clinical, angiographic characteristics and prognosis using data-sets of VA-KOREA.

Results: A total of 2107 patients were enrolled to the registry. 432 patients (20.5%) demonstrated positive result on provocation and 693 patients (32.9%) showed negative. In positive group, the numbers of male and current smokers were higher than in negative group (p<0.05). Baseline hsCRP and triglyceride were higher in positive group (0.9±0.2 vs 0.6±0.4 mg/dL, 151.8±98.6 vs 129.3±86.1 mg/dL, p<0.05). In angiographic analysis for 432 "positive", multi-vessel spasm occurred in 106 patients (24.5%). Right coronary artery (RCA) was the most common coronary artery for provoked spasm (58.1%). Diffuse type of spasm is more frequent than focal type (65.9% vs 34.1%). Out of 634 coronary segments on which spasm was provoked, 365 segments (57.6%) were associated with minimal fixed atherosclerosis. The most frequently prescribed drug was diltiazem (347, 80.3%). During the 24-month follow-up (mean 26.7±9.4 months), 23.7% of patients had re-hospitalization or visited to emergency room due to repeated angina. However, the rate of cardiac death was very low (0.9%). Additionally, the cumulative incidences of newly developed acute coronary syndrome and arrhythmia were only 1.9% and 1.1%.

Conclusions: In clinical and angiographic analysis, positive group had more male, smokers, and higher baseline hsCRP. Positive rate of ergonovine provocation was 20.5% and RCA was the most common artery for coronary spasm. Coronary spasm was more frequently provoked on the segment with minimal stenosis than on the segment without atherosclerosis. During the 24-month follow up, the prognosis was excellent by conventional medical treatments. The VA-KOREA registry will be helpful for the establishment of clinical guidelines for VA.

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