Coronary Functional Abnormalities in Patients With Angina and Nonobstructive Coronary Artery Disease.
1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine
/ analogs & derivatives
Aged
Angina Pectoris
/ complications
Coronary Angiography
Coronary Artery Disease
/ complications
Coronary Circulation
/ physiology
Coronary Vasospasm
/ diagnostic imaging
Female
Humans
Male
Microcirculation
/ physiology
Middle Aged
Protein Kinase Inhibitors
Vascular Resistance
/ physiology
rho-Associated Kinases
IMR
Rho-kinase
coronary spasm
microvascular dysfunction
nonobstructive coronary artery disease
Journal
Journal of the American College of Cardiology
ISSN: 1558-3597
Titre abrégé: J Am Coll Cardiol
Pays: United States
ID NLM: 8301365
Informations de publication
Date de publication:
12 11 2019
12 11 2019
Historique:
received:
15
04
2019
revised:
20
08
2019
accepted:
26
08
2019
entrez:
9
11
2019
pubmed:
9
11
2019
medline:
23
5
2020
Statut:
ppublish
Résumé
Approximately one-half of patients undergoing diagnostic coronary angiography for angina have no significant coronary stenosis, in whom coronary functional abnormalities could be involved. This study examined the significance of coronary functional abnormalities in a comprehensive manner for both epicardial and microvascular coronary arteries in patients with angina and nonobstructive coronary artery disease (CAD). This study prospectively enrolled 187 consecutive patients (male/female 113/74, 63.2 ± 12.3 years), who underwent acetylcholine provocation test for coronary spasm and measurement of index of microcirculatory resistance (IMR) to evaluate coronary microvascular function, and followed them for a median of 893 days. Of all subjects, acetylcholine test identified 128 patients with vasospastic angina (VSA) (68%), and cardiac events occurred in 10 patients (5.3%) during the follow-up. Multivariable analysis revealed that IMR correlated with the incidence of cardiac events (hazard ratio: 1.05; 95% confidence interval: 1.02 to 1.09; p = 0.002) and receiver-operating characteristics (ROC) curve analysis identified IMR of 18.0 as the optimal cut-off value. Among the 4 groups based on the cut-off value of IMR and the presence of VSA, the Kaplan-Meier survival analysis showed a significantly worse prognosis in the group with high IMR (≥18.0) and VSA compared with other groups (log rank, p = 0.002). Importantly, intracoronary administration of fasudil, a Rho-kinase inhibitor, significantly ameliorated IMR in the VSA patients with increased IMR (p < 0.0001). These results indicate that in patients with angina and nonobstructive CAD, coexistence of epicardial coronary spasm and increased microvascular resistance is associated with worse prognosis, for which Rho-kinase activation may be involved.
Sections du résumé
BACKGROUND
Approximately one-half of patients undergoing diagnostic coronary angiography for angina have no significant coronary stenosis, in whom coronary functional abnormalities could be involved.
OBJECTIVES
This study examined the significance of coronary functional abnormalities in a comprehensive manner for both epicardial and microvascular coronary arteries in patients with angina and nonobstructive coronary artery disease (CAD).
METHODS
This study prospectively enrolled 187 consecutive patients (male/female 113/74, 63.2 ± 12.3 years), who underwent acetylcholine provocation test for coronary spasm and measurement of index of microcirculatory resistance (IMR) to evaluate coronary microvascular function, and followed them for a median of 893 days.
RESULTS
Of all subjects, acetylcholine test identified 128 patients with vasospastic angina (VSA) (68%), and cardiac events occurred in 10 patients (5.3%) during the follow-up. Multivariable analysis revealed that IMR correlated with the incidence of cardiac events (hazard ratio: 1.05; 95% confidence interval: 1.02 to 1.09; p = 0.002) and receiver-operating characteristics (ROC) curve analysis identified IMR of 18.0 as the optimal cut-off value. Among the 4 groups based on the cut-off value of IMR and the presence of VSA, the Kaplan-Meier survival analysis showed a significantly worse prognosis in the group with high IMR (≥18.0) and VSA compared with other groups (log rank, p = 0.002). Importantly, intracoronary administration of fasudil, a Rho-kinase inhibitor, significantly ameliorated IMR in the VSA patients with increased IMR (p < 0.0001).
CONCLUSIONS
These results indicate that in patients with angina and nonobstructive CAD, coexistence of epicardial coronary spasm and increased microvascular resistance is associated with worse prognosis, for which Rho-kinase activation may be involved.
Identifiants
pubmed: 31699275
pii: S0735-1097(19)37681-8
doi: 10.1016/j.jacc.2019.08.1056
pii:
doi:
Substances chimiques
Protein Kinase Inhibitors
0
1-(5-Isoquinolinesulfonyl)-2-Methylpiperazine
84477-87-2
rho-Associated Kinases
EC 2.7.11.1
fasudil
Q0CH43PGXS
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2350-2360Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.