Hypertension (HTN) is known to be a risk factor of significant coronary artery disease (CAD). However, currently there is no enough available data with larger study population with long-term clinical outcomes of significant coronary artery spasm (CAS) patients (pts) with HTN in real world clinical practice.Design and Method:
A total of 3,349 consecutive pts without significant CAD underwent acetylcholine (Ach) provocation test and only pts with significant CAS were enrolled. Significant CAS was defined as > 70% of narrowing by incremental intracoronary injection of 20, 50 and 100 μg into left coronary artery. Pts were divided into two groups based on the presence of HTN: the HTN group (n = 1,489), the Normotensive group (n = 1,860). To adjust potential confounders, a propensity score matched (PSM) analysis was performed using the logistic regression model.Results:
After PSM analysis, 2 propensity-matched groups (1,143 pairs, n = 2,286, C-statistic = 0.720) were generated and, the baseline characteristics of the two groups were balanced. In clinical outcomes up to 5-year, there were similar incidence of individual hard endpoints including mortality, myocardial infarction, revascularization and recurrent angina requiring repeat coronary angiography. Hypertension was not an independent predictor of adverse clinical outcomes in pts with CAS (Table).Conclusions:
Despite the expected endothelial dysfunction, hypertension was not associated with a worsening factor for adverse clinical outcomes in pts with significant CAS documented by intracoronary Ach provocation test, suggesting that the mechanisms and risk factors of CAS may be different from those of atherosclerotic CAD.