論文

査読有り 国際誌
2019年11月12日

Coronary Functional Abnormalities in Patients With Angina and Nonobstructive Coronary Artery Disease.

Journal of the American College of Cardiology
  • Akira Suda
  • ,
  • Jun Takahashi
  • ,
  • Kiyotaka Hao
  • ,
  • Yoku Kikuchi
  • ,
  • Tomohiko Shindo
  • ,
  • Shohei Ikeda
  • ,
  • Koichi Sato
  • ,
  • Jun Sugisawa
  • ,
  • Yasuharu Matsumoto
  • ,
  • Satoshi Miyata
  • ,
  • Yasuhiko Sakata
  • ,
  • Hiroaki Shimokawa

74
19
開始ページ
2350
終了ページ
2360
記述言語
英語
掲載種別
DOI
10.1016/j.jacc.2019.08.1056

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.

リンク情報
DOI
https://doi.org/10.1016/j.jacc.2019.08.1056
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/31699275
ID情報
  • DOI : 10.1016/j.jacc.2019.08.1056
  • PubMed ID : 31699275

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