150 - Coronary Plaque Distribution, Severity and Cut-Off Stenosis for Developing Spasm in Patients with Vasospastic Angina: In-Depth Analysis of Atherosclerosis in Patients with Vasospastic Angina from VA-Korea Registry, A Prospective Multi-Center Cohort (ID 70)
Abstract
Background and Aims
Although coronary vasospasm usually occurs at atherosclerotic plaque, plaque distribution, frequency, and cut-off value of diameter percent stenosis for developing vasospasm are uncertain.
Methods
We enrolled 2960 patients who received coronary angiography and ergonovine provocation test prospectively. Among them, 1836 were diagnosed with variant angina (VA) and 867 non-VA. Overall plaque frequency, diameter stenosis were compared between 2 groups. Plaque status was compared among index-coronary spasm positive patients, those with index arterial spasm negative/other arterial spasm positive [INOP] and non-VA patients. Diameter stenosis determining spasm positivity was pursued.
Results
Overall plaque frequency and stenosis were higher in VA patients than in non-VA: for frequency, 22.5 vs. 12.6 % (p<0.001) in LAD, 9.4 vs. 3.2% (p<0.001) in LCx, 16.8 vs. 6.6 % (p<0.001) in RCA; for % stenosis, 36.6 vs. 32.4% (p=0.010) in LAD, 36.1 vs. 28 % (p<0.001) in LCx, 35.3 vs.30.0% (p=0.047) in RCA.
Diameter stenosis of LAD, in LAD spasm positive vs. LAD INOP vs. non-VA were 38.3%, 34.0%, 32% (P= 0.002) with similar pattern in LCx and RCA. By multivariate Cox regression analysis, stenosis of LAD ≥35% or LCx ≥35% or RCA ≥ 40% was independent predictor of spam development (OR 2.019, C.I. 1.315-3.100, P= 0.001).
Conclusions
Spasm related and unrelated coronary in VA patients had higher plaque frequency and burden than those in non-VA patients. Plaque burden at index coronary was highest in spasm related coronary, middle in INOP and lowest non-VA. Coronary stenosis of ≥35% - 40% was independent determinant for spam occurrence.
