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Because clinical characteristics and prognosis of patients with multi-vessel vasospastic angina (VSA) are not clearly elucidated, we investigate the nature and prognosis of multi-vessel VSA compared with single vessel VSA and no VSA.
Among 2960 patients enrolled in the VA-KOREA (Vasospastic Angina in Korea) registry, we identified 104 definite multi-vessel VSA patients, 163 definite single vessel VSA patients, and 737 negative patients using the intracoronary ergonovine provocation test. All patients were on recommended drug treatments by the attending physician’s discretion. The primary composite endpoint was 24-month incidence of cardiac death, new onset arrhythmia and acute coronary syndrome. Emergency room revisits were also reported.
The baseline characteristics and medical treatments between multi-vessel VSA and single vessel VSA groups did not differ significantly. The primary composite endpoint 24 month follow up were significantly higher in the multi-vessel VSA group than in the single vessel VSA and negative groups (13.64% vs 1.08% and 1.92%, p<0.05 and p<0.05, respectively). Of interest, the rate of ACS was higher in the multi-vessel VSA group than in single vessel and negative group (6.06% vs 0% and 1.37%, p<0.05 and p<0.05, respectively). Multi-vessel VSA showed low primary endpoint-free survival rate during 36 months follow up compared with the single vessel VSA (HR 3.54, 95% CI [1.16-10.79], p=0.02) and the negative group (HR 7.16, 95% CI [1.79-28.66], p<0.0001) in Kaplan-Meier survival analysis. In addition, multi-vessel VSA was one of the independent predictor of the primary composite endpoint at 36 months (OR 9.57, 95% CI [2.27-41.91], p=0.002).
The prognosis of the multi-vessel VSA in the intracoronary ergonovine provocation test was worse than those of single vessel VSA and the negative group even with recommended drug treatments. Careful detection and more intensive treatment should be given to multi-vessel VSA.
CORONARY: Angiography and QCA