Prognostic value of an abnormal response to acetylcholine in patients with angina and non-obstructive coronary artery disease: Long-term follow-up of the Heart Quest cohort.

Schoenenberger, Andreas; Adler, Eric; Gujer, Samuel; Jamshidi, Peiman; Kobza, Richard; Stuck, Andreas; Resink, Therese J; Erne, Paul (2016). Prognostic value of an abnormal response to acetylcholine in patients with angina and non-obstructive coronary artery disease: Long-term follow-up of the Heart Quest cohort. International journal of cardiology, 221, pp. 539-545. Elsevier 10.1016/j.ijcard.2016.07.035

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BACKGROUND This study aims to determine whether small vessel disease (SVD) or vasospastic disease (VSD) has an impact on prognosis. METHODS The prospective cohort embraced 718 patients with angina equivalent symptoms and no coronary stenosis ≥50% recruited between 1997 and 2008. At baseline, patients were classified as having SVD, VSD, other cardiac disease or non-cardiac problem based on intracoronary acetylcholine application and fast atrial pacing during coronary angiography. Patients underwent follow-up between 2007 and 2015. Prognostic significance of the diagnosis on cardiovascular events (cardiovascular death or non-fatal myocardial infarction) was evaluated using Cox proportional hazards models adjusted for age and sex. RESULTS The mean follow-up duration was 11.3±2.7years. Only 11 patients (1.5%) were lost to follow-up, resulting in an analyzed population of 707 patients. Patients with SVD (HR: 4.9, 95% CI: 1.1-22.4, P=0.040) and VSD (HR: 4.8, 95% CI: 1.0-23.4, P=0.050) had an increased risk of suffering cardiovascular events compared to patients with non-cardiac problems. Among SVD patients, those with the presence of endothelial dysfunction had a particularly high risk (HR: 7.3, 95% CI: 1.5-35.5, P=0.015). Among patients with SVD or VSD, those having persisting or worsening angina during follow-up had a higher risk than patients in whom angina improved (HR: 4.8, 95% CI: 1.9-12.3, P=0.001). CONCLUSIONS Our study shows that patients with SVD or VSD have an increased risk of cardiovascular events. This particularly applies to SVD patients with endothelial dysfunction. Symptoms should be taken seriously in SVD and VSD patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01318629.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Geriatric Clinic > Geriatric Clinic Inselspital

UniBE Contributor:

Schoenenberger, Andreas and Stuck, Andreas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0167-5273

Publisher:

Elsevier

Language:

English

Submitter:

Rebecca Rufer

Date Deposited:

06 Mar 2017 09:18

Last Modified:

20 Apr 2017 14:52

Publisher DOI:

10.1016/j.ijcard.2016.07.035

PubMed ID:

27414736

Uncontrolled Keywords:

Angina pectoris; Coronary artery disease; Microvascular angina; Variant

BORIS DOI:

10.7892/boris.95544

URI:

https://boris.unibe.ch/id/eprint/95544

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