Impact of old age on clinical and angiographic characteristics of coronary artery spasm as assessed by acetylcholine provocation test.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Insignificant coronary artery disease (n=3155). Intervention: Old age (≥ 65 years) vs. Young age ( 70% luminal narrowing) (OR 2.60, 95% CI 2.019-3.244, p=<0.001).

Q: What does this research mean for the field?

Old age (≥ 65 years) is an independent predictor for acetylcholine-induced significant coronary artery spasm, associated with a 2.60-fold increased odds compared to patients under 45 years. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Woong Choi; Soo Hyun Kim; Seung‐Woon Rha; Kang Yin Chen; Yong Jian Li; Byoung Geol Choi; Se Yeon Choi; Jin Won Kim; Eung Ju Kim; Chang Gyu Park; Hong Seog Seo; Dong Joo Oh

doi:10.11909/j.issn.1671-5411.2016.10.005

October 1, 2016

Impact of old age on clinical and angiographic characteristics of coronary artery spasm as assessed by acetylcholine provocation test.

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Key result

Old age (≥ 65 years) was an independent predictor for acetylcholine-induced significant coronary artery spasm, with an OR of 2.60 compared to patients under 45 years.

Why the study?

Does old age predict acetylcholine-induced coronary artery spasm in patients with insignificant coronary artery lesions?

Study Design

Type

Cohort (n=3,155)

Multicenter

No

Structured PICO

Does old age predict acetylcholine-induced coronary artery spasm in patients with insignificant coronary artery lesions?

P

Population

3,155 consecutive patients with chest pain and insignificant coronary artery disease (diameter stenosis <50% on quantitative coronary angiography), divided into four age groups (<45, 45-54, 55-64, and ≥65 years).

I

Intervention

Intracoronary acetylcholine (Ach) provocation test (incremental doses of 20, 50, and 100 µg/min infused into the left coronary artery over 60 seconds with 5-minute intervals).

C

Comparator

Comparison among four age groups: <45 years (Group 1), 45-54 years (Group 2), 55-64 years (Group 3), and ≥65 years (Group 4).

O

Outcome

Incidence of significant coronary artery spasm (CAS), defined as >70% luminal narrowing of coronary arteries during Ach provocation test.surrogate

Main Result

Effect estimate: OR 2.60 (95% CI 2.019-3.244)

Absolute Event Rate: 61.5% vs 47.36%

p-value: p=<0.001

Limitations

Potential confounders such as smoking could not be completely ruled out despite multivariate analysis.
Acetylcholine provocation test and ergonovine test were not performed simultaneously.
Incidence of coronary artery spasm could be overestimated because some atypical chest pain patients might have endothelial dysfunction without anginal chest pain.
Potential confounders not completely ruled out (e.g., smoking)
Did not simultaneously perform Ach provocation test and ergonovine test
Incidence of CAS could be overestimated due to definition (>70% narrowing irrespective of ischemic chest pain)

Implication

Old age is an independent predictor of acetylcholine-induced coronary artery spasm, suggesting it should be considered as a differential diagnosis for ischemic chest pain in elderly patients.

Abstract

BACKGROUND: Smoking and other risk factors have been well known as important factors of variant angina or coronary artery spasm (CAS). However, clinical features related to age on coronary artery spasm have been rarely evaluated. METHODS: We evaluated 3155 consecutive patients with insignificant coronary artery lesion. Patients underwent Acetylcholine (Ach) provocation test for induction of CAS. CAS was defined as > 70% luminal narrowing of coronary arteries during Ach provocation test. The results of Ach provocation test were compared among age groups; < 45 years (Group 1), 45-54 years (Group 2), 55-64 years (Group 3), and ≥ 65 years (Group 4). Multivariate logistic analysis showed that age, male, and myocardial bridge were independent predictors of CAS induced by Ach provocation test. CONCLUSION: Our present study showed that old age was independent predictor for Ach-induced significant coronary artery spasm.

Discussion

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Cite This Study

Choi et al. (2016) conducted a cohort in Insignificant coronary artery disease (n=3,155). Old age (≥ 65 years) vs. Young age (< 45 years) was evaluated on Acetylcholine-induced significant coronary artery spasm (>70% luminal narrowing) (OR 2.60, 95% CI 2.019-3.244, p=<0.001). Old age (≥ 65 years) was an independent predictor for acetylcholine-induced significant coronary artery spasm, with an OR of 2.60 compared to patients under 45 years.

synapsesocial.com/papers/6a1b38425853c704fce59291 https://doi.org/10.11909/j.issn.1671-5411.2016.10.005

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Impact of old age on clinical and angiographic characteristics of coronary artery spasm as assessed by acetylcholine provocation test.

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Impact of old age on clinical and angiographic characteristics of coronary artery spasm as assessed by acetylcholine provocation test.

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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