TCT-609 Incidence, diagnosis and clinical outcomes of patients with impaired coronary vasoreactivity: insights from a protocol of systematic coronary artery spasm detection over ten years.

Background: Non-specific chest symptoms associated with coronary artery spasm (CAS) remain underdiagnosed and consequently undertreated. Our center applies a policy of systematic CAS detection by provocative tests (PT) in normal or near normal coronary arteries in patients with symptoms compatible with vasospastic origin. We retrospectively studied the prevalence of CAS, safety of PTs and patient outcome over a 10-year period. Methods: From December 2002 to July 2012, 13,902 patients underwent 18,454 coronary angiographies. 5,962 of these patients with normal or near normal arteries underwent 2,397 PTs. 256 were consequently diagnosed with CAS (10.7%). In addition, among the 7,940 patients with a 50% stenosis on coronary angiography, 44 patients were diagnosed as having a spontaneous CAS (0.6%). Results: Compared to the overall population, patients with CAS were more often female (44.7% vs. 29.6%; p<0.0001), younger (55 [47.5-64] years vs. 61 [52-70] years; p1⁄40.0001), and more often smokers (63.7% vs. 42.3%; p<0.0001). Initial presentation was more frequently acute coronary syndrome (37.4% vs. 28.9%) and non-specific chest pain (41.8% vs. 21.6%). Sixty-nine patients had refractory CAS when PT was abnormal under antispastic treatment. 99.1% of the patients who underwent a PT had an event-free hospital course. At 46 months, the all-cause death rate, myocardial infarction, stroke and revascularization in CAS patients were 4.3%, 3.3%, 0% and 4.3%, respectively. Conclusions: This retrospective study of 10 years of experience suggests that CAS is present in as many as 10.7% of patients with chest symptoms at rest. PT seems to be safe in patients with normal or near normal coronary angiography. These findings could justify performing PTs more systematically in this setting to avoid the potentially severe outcomes of undiagnosed CAS.