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Which Coronary Artery Should Be Preferred for Starting the Coronary Spasm Provocation Test?

Background: The spasm provocation test (SPT) is a critical test for diagnosing vasospastic angina (VSA). However, the choice of vessel to be preferred for initiating the SPT—the right coronary artery (RCA) or the left coronary artery (LCA)—is unclear. This study aimed to assess SPT results including...

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Autores principales: Teragawa, Hiroki, Uchimura, Yuko, Oshita, Chikage, Hashimoto, Yu, Nomura, Shuichi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10608489/
https://www.ncbi.nlm.nih.gov/pubmed/37895453
http://dx.doi.org/10.3390/life13102072
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author Teragawa, Hiroki
Uchimura, Yuko
Oshita, Chikage
Hashimoto, Yu
Nomura, Shuichi
author_facet Teragawa, Hiroki
Uchimura, Yuko
Oshita, Chikage
Hashimoto, Yu
Nomura, Shuichi
author_sort Teragawa, Hiroki
collection PubMed
description Background: The spasm provocation test (SPT) is a critical test for diagnosing vasospastic angina (VSA). However, the choice of vessel to be preferred for initiating the SPT—the right coronary artery (RCA) or the left coronary artery (LCA)—is unclear. This study aimed to assess SPT results including SPT-related complications while initiating the SPT in the RCA and LCA. Methods: We enrolled 225 patients who underwent coronary angiography and SPTs. The SPT was first performed in the RCA in 133 patients (RCA group) and the LCA in 92 patients (LCA group). We defined VSA as >90% narrowing of the coronary artery during the SPT, accompanied by chest pain and/or ST–T changes on the electrocardiogram. When coronary spasm occurs in two or more major coronary arteries, it is referred to as a multivessel spasm (MVS). SPT-related complications comprised atrial fibrillation, ventricular fibrillation, and unstable hemodynamics following catecholamine use. Analyses using propensity score matching (PSM) were performed in 120 patients. Results: No significant differences in the frequencies of VSA and complications were observed between the two groups (RCA: 79% and 19%, respectively; LCA: 85% and 22%, respectively). In both groups, spasms were most frequently provoked in the left anterior descending coronary artery (both p < 0.001) whereas spasms in the left circumflex coronary artery (LCX) were higher in the LCA group than in the RCA group (p = 0.015). Furthermore, no significant difference in the frequency of MVS was observed between both groups (RCA: 50%, LCA: 62%; p = 0.122). After PSM, no significant difference in the frequencies of VSA and complications were observed between the two groups (RCA: 82% and 15%, respectively; LCA: 88% and 18%, respectively). The frequencies of LCX spasms (RCA: 8%, LCA: 23%; p = 0.022) and MVS (RCA: 40%, LCA: 62%; p = 0.020) were higher in the LCA group than in the RCA group. Conclusions: Although the diagnostic rate of VSA and frequency of SPT-related complications were similar in the two groups, the frequency of MVS was higher in the LCA group than in the RCA group because of the increase in the number of LCX spasms. A routine SPT may be started from the LCA.
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spelling pubmed-106084892023-10-28 Which Coronary Artery Should Be Preferred for Starting the Coronary Spasm Provocation Test? Teragawa, Hiroki Uchimura, Yuko Oshita, Chikage Hashimoto, Yu Nomura, Shuichi Life (Basel) Article Background: The spasm provocation test (SPT) is a critical test for diagnosing vasospastic angina (VSA). However, the choice of vessel to be preferred for initiating the SPT—the right coronary artery (RCA) or the left coronary artery (LCA)—is unclear. This study aimed to assess SPT results including SPT-related complications while initiating the SPT in the RCA and LCA. Methods: We enrolled 225 patients who underwent coronary angiography and SPTs. The SPT was first performed in the RCA in 133 patients (RCA group) and the LCA in 92 patients (LCA group). We defined VSA as >90% narrowing of the coronary artery during the SPT, accompanied by chest pain and/or ST–T changes on the electrocardiogram. When coronary spasm occurs in two or more major coronary arteries, it is referred to as a multivessel spasm (MVS). SPT-related complications comprised atrial fibrillation, ventricular fibrillation, and unstable hemodynamics following catecholamine use. Analyses using propensity score matching (PSM) were performed in 120 patients. Results: No significant differences in the frequencies of VSA and complications were observed between the two groups (RCA: 79% and 19%, respectively; LCA: 85% and 22%, respectively). In both groups, spasms were most frequently provoked in the left anterior descending coronary artery (both p < 0.001) whereas spasms in the left circumflex coronary artery (LCX) were higher in the LCA group than in the RCA group (p = 0.015). Furthermore, no significant difference in the frequency of MVS was observed between both groups (RCA: 50%, LCA: 62%; p = 0.122). After PSM, no significant difference in the frequencies of VSA and complications were observed between the two groups (RCA: 82% and 15%, respectively; LCA: 88% and 18%, respectively). The frequencies of LCX spasms (RCA: 8%, LCA: 23%; p = 0.022) and MVS (RCA: 40%, LCA: 62%; p = 0.020) were higher in the LCA group than in the RCA group. Conclusions: Although the diagnostic rate of VSA and frequency of SPT-related complications were similar in the two groups, the frequency of MVS was higher in the LCA group than in the RCA group because of the increase in the number of LCX spasms. A routine SPT may be started from the LCA. MDPI 2023-10-17 /pmc/articles/PMC10608489/ /pubmed/37895453 http://dx.doi.org/10.3390/life13102072 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Teragawa, Hiroki
Uchimura, Yuko
Oshita, Chikage
Hashimoto, Yu
Nomura, Shuichi
Which Coronary Artery Should Be Preferred for Starting the Coronary Spasm Provocation Test?
title Which Coronary Artery Should Be Preferred for Starting the Coronary Spasm Provocation Test?
title_full Which Coronary Artery Should Be Preferred for Starting the Coronary Spasm Provocation Test?
title_fullStr Which Coronary Artery Should Be Preferred for Starting the Coronary Spasm Provocation Test?
title_full_unstemmed Which Coronary Artery Should Be Preferred for Starting the Coronary Spasm Provocation Test?
title_short Which Coronary Artery Should Be Preferred for Starting the Coronary Spasm Provocation Test?
title_sort which coronary artery should be preferred for starting the coronary spasm provocation test?
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10608489/
https://www.ncbi.nlm.nih.gov/pubmed/37895453
http://dx.doi.org/10.3390/life13102072
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