Author + information
- Ji Young Park1,
- Byoung Geol Choi2,
- Seung-Woon Rha2,
- Se Yeon Choi2,
- Jae Kyeong Byun2,
- Cheol Ung Choi2 and
- Dong Joo Oh2
Accumulating evidence has demonstrated the gender differences in the clinical characteristics and outcomes of patients with ischemic heart disease. However, it remains to be elucidated whether it is also similar in the case of patients with coronary artery spasm (CAS). The aim of this study is to estimate whether there are gender differences in the clinical characteristics and long-term prognosis of CAS.
A total of 10,177 patients with typical or atypical chest pain, underwent coronary angiography (CAG) at the Cardiovascular Center of Korea University Guro Hospital, Seoul, South Korea between November 2004 and May 2014 were enrolled in this study. Among these, 6,430 patients with typical or atypical chest pain without significant coronary artery disease (defined as having a stenosis diameter of less than 70% on the quantitative coronary angiography, QCA) underwent the intracoronary acetylcholine (Ach) provocation test. Of the total, 5,491 patients were enrolled for this study and divided into the two groups; male group (n=2,506), female group (n=2,985). We compared the rate of significant CAS, major adverse cardiovascular events (MACE) and repeated CAG between the two groups.
As compared with male patients, female patients were associated with lower incidence of Ach-induced CAS (51% vs. 62%. P<0.01) in entire patients and most of the sub-groups, however, the incidence of ST elevation and ischemic chest pain during Ach provocation test were higher in the female gender. In both groups, old age, dyslipidemia, and myocardial bridge were independent predictors of Ach-induced CAS. However, diabetes mellitus in male group and alcohol drinkers in the female group were an independent predictor of Ach-induced CAS. Hypertension or uncontrolled blood pressure was associated with lower incidence of Ach-induced CAS within both groups. However, there were no differences in various clinical outcomes up to 5-year between the two groups except higher trend of de novo PCI in the male group. In CAS patients, in male, old age and insignificant stenosis (50-70%) were independent predictors of 5-year MACE, and insignificant stenosis (30-50%) and use of chronic nitrates were predictors of 5-year recurrent angina. In CAS patients, in the female, insignificant stenosis (30-50%) and use of diuretics were independent predictors of 5-year MACE, and dyslipidemia, myocardial bridge and use of chronic nitrates were predictors of 5-year recurrent angina.
These results indicate that there are gender differences in the angiographic and clinical parameters during the Ach provocation test and clinical outcomes up to 5 years in CAS patients, suggesting the importance of gender-specific management of this particular subset of patients.