Key result
Coronary stent implantation was associated with a significantly higher prevalence of provoked coronary vasospasm compared to non-stented coronary artery disease (25.1% vs 13.8%, p=0.0138).
Why the study?
The frequency of coronary spasm with angiographic myocardial ischemia and its occurrence after coronary stent implantation by stent type were not well characterized.
Does coronary stenting and the type of stent affect the frequency of coronary spasm in patients with coronary artery disease?
Observational (n=1,699)
No
Does coronary stenting and the type of stent affect the frequency of coronary spasm in patients with coronary artery disease?
Absolute Event Rate: 25.1% vs 13.8%
p-value: p=0.0138
Coronary stenting, particularly with 1st generation DES, is associated with an increased frequency of coronary spasm, highlighting the need for provocation testing in patients with chest pain after stenting even in the absence of restenosis.
Suggests considering vasospasm in post-stent patients with recurrent chest pain without restenosis;.
【目的】冠動脈疾患における血管造影上の心筋虚血を伴う冠攣縮の出現頻度と，冠動脈ステント留置後の冠攣縮の出現頻度をステントの種類別に検討した．【対象と方法】冠攣縮誘発試験 (エルゴノビン冠動脈注入法) を行った連続1,699例 (男性967例，女性732例，平均68±12歳)．そのうち，冠動脈に75%以上の器質的狭窄のある冠動脈疾患325例 (ステント留置195例，非留置130例)．BMS (bare metal stent) 21例，第1世代DES (drug-eluting stent) 29例，第2世代DES 79例．第3世代DES 66例．陽性基準は一過性の90%以上の冠攣縮で胸痛，心電図異常を伴うものとした．【結果】血管造影上の心筋虚血を伴う冠攣縮の出現頻度は冠動脈疾患20.6%，非冠動脈疾患14.5%と，冠動脈疾患で有意 (p=0.0062) に多かった．また冠動脈疾患ではステント留置例25.1%，非留置例13.8%と，ステント留置例で有意 (p=0.0138) に多かった．ステントの種類別ではBMS 23.8%，第1世代DES 48.3%，第2世代DES 25.3%，第3世代DES 15.2%で，第1世代DESに出現頻度が高かった．【結語】冠動脈疾患では血管造影上の心筋虚血を伴う冠攣縮の出現頻度が多く，また冠動脈ステント留置例ではさらに多かった．ステント留置早期では第1世代DESで冠攣縮が多く，第3世代DESで少ない傾向を示した．【結語】ステント留置後再狭窄がなくても，胸痛発作のある症例では冠攣縮誘発試験が必要である．
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Kentaro Matsumura (2017) conducted an observational in Coronary artery disease and suspected vasospastic angina (n=1,699). Coronary stent implantation vs. No coronary stent implantation (non-PCI-stent) was evaluated on Prevalence of angiographic coronary vasospasm with myocardial ischemia during ergonovine provocation test (p=0.0138). Coronary stent implantation was associated with a significantly higher prevalence of provoked coronary vasospasm compared to non-stented coronary artery disease (25.1% vs 13.8%, p=0.0138).
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