- Email: [email protected]
TCT-498 Lower mortality in patients with vasospastic angina who receive statin therapy: Data from the Asan Vasospastic Angina Registry
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016
in a dedicated software (QAngio XA, Medis, Leiden, The Netherlands) by an independent Core Lab blinded to the type of stent used. Statistical analyses were carried out in JMP software (SAS, Cary, USA) at a 2-sided alpha level of 0.05. RESULTS Twenty subjects (10 SES x 10 BMS) were included in this analysis. Baseline characteristics were similar in both groups. After higher-dose Ach infusion, there was no difference in percentage variation of proximal (BMS: -0.002 þ 0.067% vs SES: -0.009 þ 0.187%, p¼0.040), reference (BMS: -0.030 þ 0.069% vs SES: -0.022 þ 0.049%, p¼0.54) and distal mean diameters (BMS: -0.081 þ 0.122% vs SES: 0.008 þ 0.068%, p¼0.06). CONCLUSION Unlike DES with durable polymer, this new biodagradable polymer CrCo-SES was not associated with long-term vasomotion impairment in peristent segments, as compared to its counterpart BMS. CATEGORIES CORONARY: Angiography and QCA TCT-496 Differences in quantitative coronary angiographic (QCA) characteristics of coronary artery disease between Human Immunodeficiency Virus (HIV) patients presenting with acute coronary syndrome (ACS) and stable angina pectoris (SAP) undergoing percutaneous coronary intervention (PCI) Kleanthis Theodoropoulos,1 Omar Meelu,2 Marco Mennuni,3 Samantha Sartori,4 Jennifer Yu,5 Usman Baber,6 Giulio Stefanini,7 Ioannis Mastoris,8 Pedro Moreno,9 George Dangas,10 Roxana Mehran,11 Samin Sharma,12 Annapoorna Kini13 1 Icahn School of Medicine at Mount Sinai, Bronx, New York, United States; 2 Mount Sinai Hospital, New York, New York, New York, United States; 3 Mount Sinai Hospital, New York, New York, United States; 4The Icahn School of Medicine at Mount Sinai, New York, New York, United States; 5 Mount Sinai Medical Center, New York, New York, United States; 6Mount Sinai Medical Center, New York, New York, United States; 7Humanitas Research Hospital, Rozzano, Milan, Italy; 8Icahn School of Medicine at Mount Sinai, New York, New York, United States; 9Mount Sinai Medical Center, New York, New York, United States; 10Mount Sinai Medical Center, New York, New York, United States; 11Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States; 12The Mount Sinai Medical Center, New York, New York, United States; 13Unknown, New York, New York, United States BACKGROUND While alteration in genesis and progression of atherosclerosis in Human Immunodeficiency Virus (HIV) patients results to increased rates of acute coronary syndromes (ACS) in this cohort, the angiographic phenotype and coronary lesion characteristics of HIV patients presenting with ACS as compared to those with stable angina pectoris (SAP) have not yet been described. METHODS This is a retrospective and single-center study comparing HIV patients presenting with ACS to SAP who underwent PCI between 2003-2011. Quantitative coronary angiography (QCA) was performed for all treated lesions at baseline and following PCI in both groups. 1Year clinical outcomes post-PCI were also analyzed and compared. RESULTS Patients presented with ACS (n¼44) were of lower body mass index, had more frequently hyperlipidemia, history of peripheral vascular disease, higher CRP levels and reduced ejection fraction as compared to SAP patients (n¼46). In addition, they were more likely to be on statin and aspirin on admission and more often discharged on statin. Significant differences in coronary artery disease (CAD) burden and lesion morphology were detected between the two groups. ACS patients had higher grade of stenosis and extent of CAD as measured by presence of multi-vessel disease as well as SYNTAX score (Table). ACS lesions were also longer, more frequently AHA type C, and were located less frequently on left anterior descending artery (LAD). Per patient
Acute Coronary
Stable Angina Pectoris
characteristics
Syndrome (n [ 44)
(n [ 46)
Number of diseased
p value 0.03
vessels 1-vessel
17 (38%)
20 (43%)
2-vessel
13 (30%)
21 (46%)
3-vessel
14 (32%)
5 (11%)
SYNTAX Score Per lesion characteristics
14 9.2
11.2 5.7
0.05
Acute Coronary
Stable Angina Pectoris
p value
Syndrome (n [ 66)
(n [ 75)
Lesion length (mm)
19.1 13.6
15.4 8.0
0.05
MLD
0.72 0.55
1.01 0.49
<0.001
Diameter stenosis (%)
72.9 14.7
64.5 12.9
<0.001
B199
CONCLUSION In this first HIV QCA study, ACS compared to SAP patients displayed a higher burden of coronary atherosclerosis and more complex lesions, including grade of obstruction, plaque composition and length, providing unique insights regarding angiographic phenotype in this clinical setting. CATEGORIES CORONARY: Angiography and QCA TCT-497 A Novel Scoring System Predicting Major Adverse Cardiac Events in Coronary Artery Spasm Patients: A Large-scale Simulation Analysis Jun Hyuk Kang,1 Seung-Woon Rha,2 Byoung Geol Choi,3 Jae Kyeong Byun,4 Se Yeon Choi,5 Woo Hyeun Kim,6 Ja Yeon Choi,7 James Hall,8 Sung Hun Park,9 SunKi Lee,10 Hu Li,11 Jin Oh Na,12 Cheol Ung Choi,13 Jin Won Kim,14 Hong Euy Lim,15 Eung Ju Kim,16 Chang Gyu Park,17 Hong-Seog Seo,18 Dong Joo Oh19 1 Royal Infirmary of Edinburgh; 2Korea University Guro Hospital, Seoul, Korea, Republic of; 3Korea University Guro Hospital, Huelva; 4The James Cook University Hospital; 5Durham University; 6The James Cook University Hospital; 7The James Cook University Hospital; 8The James Cook University Hospital, United States; 9The James Cook University Hospital; 10The James Cook University Hospital; 11Korea University Anam Hospital; 12Samsung medical center; 13Korea University Guro Hospital, Seoul, Korea, Republic of; 14Unknown, Seoul, Korea, Republic of; 15Shree B.D. Mehta Mahavir Heart Institute, Surat, Gujarat, India; 16 Pariyaram Medical College, Kannur, Kerala, India; 17Apollo Hospitals International Limited, Gandhinagar, Gujarat, India; 18Unknown, Seoul, Korea, Republic of; 19Korea university Guro Hospital, Seoul, Korea, Republic of BACKGROUND In previous studies, some clinical risk factors were found to be associated with adverse cardiac events in coronary artery spasm (CAS) patients, however, combinatorial effects of those risk factors have not been systematically evaluated yet. This study is to develop a novel scoring system which effectively predicts major adverse cardiac events (MACEs) in CAS patients through large-scale simulation analysis. METHODS A total 3477 patients without significant coronary artery disease who underwent acetylcholine (Ach) provocation test between Nov. 2004 and Jan. 2013 were enrolled. Among baseline clinical and angiographic characteristics during the provocation test, 13 factors were included in the scoring system. Each factor can take one of the three scores (i.e., 0, 1, 2), generating total 1,594,322 (313) different scoring systems. In each scoring system, patients were divided into two groups (i.e., low score group and high score group) using a mean score of whole patients as a cutoff value. To compare the 5-year MACE between the two groups for each scoring system, survival analysis was performed according to the Kaplan-Meier method with two-sided logrank tests. MACE was defined as the composite of total death, cardiac death, any myocardial infarction, de novo percutaneous coronary intervention, repeat revascularization, and recurrent angina. RESULTS Among 1,594,322 scoring systems, 15,483 (1.0%) predicted MACE with statistical significance, representing the validity of included risk factors. Scoring system with the best performance was ‘2*ST elevation (0 or 1) þ ST depression (0 or 1) þ T wave inversion (0 or 1) þ 2*Atrial fibrillation (0 or 1) þ Chest pain (0 or 1) þ 2*Atrioventricular block (0 or 1)’ during the provocation test (HR¼1.9, p value<0.001). Among the risk factors, ECG changes were consistently included in the scoring systems with high performance (HR>1.5, p value<0.05). CONCLUSION Through the large-scale simulation analysis, we presented a scoring system predicting MACE in CAS patients. ECG changes needs to be carefully observed during the provocation tests since they were found to be important predictors. CATEGORIES CORONARY: Angiography and QCA TCT-498 Lower mortality in patients with vasospastic angina who receive statin therapy: Data from the Asan Vasospastic Angina Registry Cheol Hyun Lee,1 Osung Kwon,2 Ungjeong Do,3 Jung Ae Hong,4 Kyusup Lee,5 Min Soo Cho,6 Jaeseok Bae,7 Do-yoon Kang,8 Se Hun Kang,9 Pil Hyung Lee,10 Sung-Han Yoon,11 Jung-Min Ahn,12 Duk-Woo Park,13 Soo-Jin Kang,14 Seung-Whan Lee,15 Young-Hak Kim,16 Cheol Whan Lee,17 Seong-Wook Park,18 Seung-Jung Park19 1 Asan medical center, seoul, Korea, Republic of; 2Asan Medical Center, Seoul, Korea, Republic of; 3Seoul National University Hospital, Seoul, Korea, Republic of; 4Asan Medical Center, Seoul, Korea, Republic of; 5 AMC, Seoul, Korea, Republic of; 6Asan medical center, Seoul, Korea,
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016
Republic of; 7Asan medical center, Seoul, Korea, Republic of; 8Asan Medical Center, Seoul, Korea, Republic of; 9Asan Medical Center, Seoul, Korea, Republic of; 10Columbia University Medical Center, Seoul, Korea, Republic of; 11Asan Medical Center, Seoul, Korea, Republic of; 12 Asan Medical Center, Seoul, Korea, Republic of; 13Asan Medical Center, Seoul, Korea, Republic of; 14Asan Medical Center, Seoul, Korea, Republic of; 15Asan Medical Center, Seoul, Korea, Republic of; 16Asan Medical Center, Seoul, Korea, Republic of; 17Asan Medical Center, Seoul, Korea, Republic of; 18Asan Medical Center, Seoul, Korea, Republic of; 19Asan Medical Center, Seoul, Korea, Republic of BACKGROUND Statin therapy is the standard treatment for atherosclerotic cardiovascular disease. However, the benefits of statin therapy in patients with vasospastic angina (VSA) remains unknown. This study investigated the long-term benefits of statin therapy in patients with VSA. METHODS Between March 1996 and September 2014, a total of 1779 VSA patients were enrolled in the ASAN VSA Registry. The primary endpoint was defined as death from any cause at a median follow-up duration of 8.1 years (interquartile range: 4.3–11.6 years). RESULTS Among the study patients, 839 patients (47.2%) were treated with statin therapy at enrollment. During the follow-up period, the statin therapy group demonstrated a lower incidence rate of death from any cause (0.67% patient-years vs 1.27% patient-years; adjusted hazard ratio [aHR] ¼ 0.51; 95% confidence interval [CI] ¼ 0.35–0.74; p < 0.001) and a lower incidence rate of cardiac death (0.07% patient-years vs 0.5% patient-years; aHR ¼ 0.10; 95% CI ¼ 0.03–0.32; p < 0.001). In addition, the subgroup analysis according to the severity of concurrent coronary artery disease was consistent with the overall findings: intermediate coronary artery disease (aHR ¼ 0.49; 95% CI ¼ 0.18–1.31; p ¼ 0.15), no or mild coronary artery disease (aHR ¼ 0.65; 95% CI ¼ 0.39–1.08; p ¼ 0.099), and unknown coronary artery disease (aHR ¼ 0.37; 95% CI ¼ 0.19–0.71; p ¼ 0.003).
CONCLUSION Administering statin therapy to patients with VSA is associated with a lower mortality rate during long-term follow-up. Statin therapy should therefore be considered as the standard treatment on top of vasodilator therapy for the treatment of VSA. CATEGORIES CORONARY: Pharmacology/Pharmacotherapy TCT-499 Influence of gender on the clinical characteristics and prognostic factors in patients with vasospastic angina da hyon lee,1 Jeong Hoon Yang,2 Joo Yong Hahn,3 Cláudia Jorge,4 sang hoon lee,5 Fausto J. Pinto,6 Seung-Hyuk Choi7 1 Columbia University Medical Center, seoul, Korea, Republic of; 2 Samsung Medical Center, Seoul, Korea, Republic of; 3Interventional Cardiologist, Seoul, Korea, Republic of; 4Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon; 5Samsung Medical Center, Seoul, Korea, Republic of; 6Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon; 7Samsung Medical Center, Seoul, Korea, Republic of BACKGROUND Men were more likely to suffer vasospastic angina (VSA) than women, but the gender difference in clinical characteristics and prognosis of VSA patients was not fully elucidated. We sought to investigate clinical characteristics and prognostic predictors in both genders of VSA patients. METHODS We included patients with positive result on intracoronary ergonovine provocation test between January 2003 and December 2014. A total of 986 patients were analyzed according to gender (male [n¼838] versus female [n¼148]) for clinical characteristics and major adverse cardiac event (MACE). MACE was defined as a composite outcome of cardiac death, acute myocardial infarction, revascularization, or re-hospitalization due to recurrent angina. RESULTS Female patients were younger and were associated with a lower prevalence of smoking and coronary stenosis, compared with male patients. The risk for MACE was similar between male and female genders (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.65 to 1.39; p ¼ 0.79). In multivariable prediction models for MACE, high-sensitivity CRP (hs-CRP) level was a significant predictor of MACE in male patients (HR, 1.95; 95% CI, 1.25 to 3.06, p ¼ 0.003), while there was no significant predictor of MACE in female patients. There was a significant interaction between hs-CRP level and MACE rate across the gender (interaction p ¼ 0.02).
CONCLUSION Gender related differences in several clinical characteristics were noted in VSA patients. Long-term clinical outcome was not different between both genders, but prognostic predictor differs according to gender. CATEGORIES OTHER: Womens Health Issues
in a dedicated software (QAngio XA, Medis, Leiden, The Netherlands) by an independent Core Lab blinded to the type of stent used. Statistical analyses were carried out in JMP software (SAS, Cary, USA) at a 2-sided alpha level of 0.05. RESULTS Twenty subjects (10 SES x 10 BMS) were included in this analysis. Baseline characteristics were similar in both groups. After higher-dose Ach infusion, there was no difference in percentage variation of proximal (BMS: -0.002 þ 0.067% vs SES: -0.009 þ 0.187%, p¼0.040), reference (BMS: -0.030 þ 0.069% vs SES: -0.022 þ 0.049%, p¼0.54) and distal mean diameters (BMS: -0.081 þ 0.122% vs SES: 0.008 þ 0.068%, p¼0.06). CONCLUSION Unlike DES with durable polymer, this new biodagradable polymer CrCo-SES was not associated with long-term vasomotion impairment in peristent segments, as compared to its counterpart BMS. CATEGORIES CORONARY: Angiography and QCA TCT-496 Differences in quantitative coronary angiographic (QCA) characteristics of coronary artery disease between Human Immunodeficiency Virus (HIV) patients presenting with acute coronary syndrome (ACS) and stable angina pectoris (SAP) undergoing percutaneous coronary intervention (PCI) Kleanthis Theodoropoulos,1 Omar Meelu,2 Marco Mennuni,3 Samantha Sartori,4 Jennifer Yu,5 Usman Baber,6 Giulio Stefanini,7 Ioannis Mastoris,8 Pedro Moreno,9 George Dangas,10 Roxana Mehran,11 Samin Sharma,12 Annapoorna Kini13 1 Icahn School of Medicine at Mount Sinai, Bronx, New York, United States; 2 Mount Sinai Hospital, New York, New York, New York, United States; 3 Mount Sinai Hospital, New York, New York, United States; 4The Icahn School of Medicine at Mount Sinai, New York, New York, United States; 5 Mount Sinai Medical Center, New York, New York, United States; 6Mount Sinai Medical Center, New York, New York, United States; 7Humanitas Research Hospital, Rozzano, Milan, Italy; 8Icahn School of Medicine at Mount Sinai, New York, New York, United States; 9Mount Sinai Medical Center, New York, New York, United States; 10Mount Sinai Medical Center, New York, New York, United States; 11Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States; 12The Mount Sinai Medical Center, New York, New York, United States; 13Unknown, New York, New York, United States BACKGROUND While alteration in genesis and progression of atherosclerosis in Human Immunodeficiency Virus (HIV) patients results to increased rates of acute coronary syndromes (ACS) in this cohort, the angiographic phenotype and coronary lesion characteristics of HIV patients presenting with ACS as compared to those with stable angina pectoris (SAP) have not yet been described. METHODS This is a retrospective and single-center study comparing HIV patients presenting with ACS to SAP who underwent PCI between 2003-2011. Quantitative coronary angiography (QCA) was performed for all treated lesions at baseline and following PCI in both groups. 1Year clinical outcomes post-PCI were also analyzed and compared. RESULTS Patients presented with ACS (n¼44) were of lower body mass index, had more frequently hyperlipidemia, history of peripheral vascular disease, higher CRP levels and reduced ejection fraction as compared to SAP patients (n¼46). In addition, they were more likely to be on statin and aspirin on admission and more often discharged on statin. Significant differences in coronary artery disease (CAD) burden and lesion morphology were detected between the two groups. ACS patients had higher grade of stenosis and extent of CAD as measured by presence of multi-vessel disease as well as SYNTAX score (Table). ACS lesions were also longer, more frequently AHA type C, and were located less frequently on left anterior descending artery (LAD). Per patient
Acute Coronary
Stable Angina Pectoris
characteristics
Syndrome (n [ 44)
(n [ 46)
Number of diseased
p value 0.03
vessels 1-vessel
17 (38%)
20 (43%)
2-vessel
13 (30%)
21 (46%)
3-vessel
14 (32%)
5 (11%)
SYNTAX Score Per lesion characteristics
14 9.2
11.2 5.7
0.05
Acute Coronary
Stable Angina Pectoris
p value
Syndrome (n [ 66)
(n [ 75)
Lesion length (mm)
19.1 13.6
15.4 8.0
0.05
MLD
0.72 0.55
1.01 0.49
<0.001
Diameter stenosis (%)
72.9 14.7
64.5 12.9
<0.001
B199
CONCLUSION In this first HIV QCA study, ACS compared to SAP patients displayed a higher burden of coronary atherosclerosis and more complex lesions, including grade of obstruction, plaque composition and length, providing unique insights regarding angiographic phenotype in this clinical setting. CATEGORIES CORONARY: Angiography and QCA TCT-497 A Novel Scoring System Predicting Major Adverse Cardiac Events in Coronary Artery Spasm Patients: A Large-scale Simulation Analysis Jun Hyuk Kang,1 Seung-Woon Rha,2 Byoung Geol Choi,3 Jae Kyeong Byun,4 Se Yeon Choi,5 Woo Hyeun Kim,6 Ja Yeon Choi,7 James Hall,8 Sung Hun Park,9 SunKi Lee,10 Hu Li,11 Jin Oh Na,12 Cheol Ung Choi,13 Jin Won Kim,14 Hong Euy Lim,15 Eung Ju Kim,16 Chang Gyu Park,17 Hong-Seog Seo,18 Dong Joo Oh19 1 Royal Infirmary of Edinburgh; 2Korea University Guro Hospital, Seoul, Korea, Republic of; 3Korea University Guro Hospital, Huelva; 4The James Cook University Hospital; 5Durham University; 6The James Cook University Hospital; 7The James Cook University Hospital; 8The James Cook University Hospital, United States; 9The James Cook University Hospital; 10The James Cook University Hospital; 11Korea University Anam Hospital; 12Samsung medical center; 13Korea University Guro Hospital, Seoul, Korea, Republic of; 14Unknown, Seoul, Korea, Republic of; 15Shree B.D. Mehta Mahavir Heart Institute, Surat, Gujarat, India; 16 Pariyaram Medical College, Kannur, Kerala, India; 17Apollo Hospitals International Limited, Gandhinagar, Gujarat, India; 18Unknown, Seoul, Korea, Republic of; 19Korea university Guro Hospital, Seoul, Korea, Republic of BACKGROUND In previous studies, some clinical risk factors were found to be associated with adverse cardiac events in coronary artery spasm (CAS) patients, however, combinatorial effects of those risk factors have not been systematically evaluated yet. This study is to develop a novel scoring system which effectively predicts major adverse cardiac events (MACEs) in CAS patients through large-scale simulation analysis. METHODS A total 3477 patients without significant coronary artery disease who underwent acetylcholine (Ach) provocation test between Nov. 2004 and Jan. 2013 were enrolled. Among baseline clinical and angiographic characteristics during the provocation test, 13 factors were included in the scoring system. Each factor can take one of the three scores (i.e., 0, 1, 2), generating total 1,594,322 (313) different scoring systems. In each scoring system, patients were divided into two groups (i.e., low score group and high score group) using a mean score of whole patients as a cutoff value. To compare the 5-year MACE between the two groups for each scoring system, survival analysis was performed according to the Kaplan-Meier method with two-sided logrank tests. MACE was defined as the composite of total death, cardiac death, any myocardial infarction, de novo percutaneous coronary intervention, repeat revascularization, and recurrent angina. RESULTS Among 1,594,322 scoring systems, 15,483 (1.0%) predicted MACE with statistical significance, representing the validity of included risk factors. Scoring system with the best performance was ‘2*ST elevation (0 or 1) þ ST depression (0 or 1) þ T wave inversion (0 or 1) þ 2*Atrial fibrillation (0 or 1) þ Chest pain (0 or 1) þ 2*Atrioventricular block (0 or 1)’ during the provocation test (HR¼1.9, p value<0.001). Among the risk factors, ECG changes were consistently included in the scoring systems with high performance (HR>1.5, p value<0.05). CONCLUSION Through the large-scale simulation analysis, we presented a scoring system predicting MACE in CAS patients. ECG changes needs to be carefully observed during the provocation tests since they were found to be important predictors. CATEGORIES CORONARY: Angiography and QCA TCT-498 Lower mortality in patients with vasospastic angina who receive statin therapy: Data from the Asan Vasospastic Angina Registry Cheol Hyun Lee,1 Osung Kwon,2 Ungjeong Do,3 Jung Ae Hong,4 Kyusup Lee,5 Min Soo Cho,6 Jaeseok Bae,7 Do-yoon Kang,8 Se Hun Kang,9 Pil Hyung Lee,10 Sung-Han Yoon,11 Jung-Min Ahn,12 Duk-Woo Park,13 Soo-Jin Kang,14 Seung-Whan Lee,15 Young-Hak Kim,16 Cheol Whan Lee,17 Seong-Wook Park,18 Seung-Jung Park19 1 Asan medical center, seoul, Korea, Republic of; 2Asan Medical Center, Seoul, Korea, Republic of; 3Seoul National University Hospital, Seoul, Korea, Republic of; 4Asan Medical Center, Seoul, Korea, Republic of; 5 AMC, Seoul, Korea, Republic of; 6Asan medical center, Seoul, Korea,
B200
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 18, SUPPL B, 2016
Republic of; 7Asan medical center, Seoul, Korea, Republic of; 8Asan Medical Center, Seoul, Korea, Republic of; 9Asan Medical Center, Seoul, Korea, Republic of; 10Columbia University Medical Center, Seoul, Korea, Republic of; 11Asan Medical Center, Seoul, Korea, Republic of; 12 Asan Medical Center, Seoul, Korea, Republic of; 13Asan Medical Center, Seoul, Korea, Republic of; 14Asan Medical Center, Seoul, Korea, Republic of; 15Asan Medical Center, Seoul, Korea, Republic of; 16Asan Medical Center, Seoul, Korea, Republic of; 17Asan Medical Center, Seoul, Korea, Republic of; 18Asan Medical Center, Seoul, Korea, Republic of; 19Asan Medical Center, Seoul, Korea, Republic of BACKGROUND Statin therapy is the standard treatment for atherosclerotic cardiovascular disease. However, the benefits of statin therapy in patients with vasospastic angina (VSA) remains unknown. This study investigated the long-term benefits of statin therapy in patients with VSA. METHODS Between March 1996 and September 2014, a total of 1779 VSA patients were enrolled in the ASAN VSA Registry. The primary endpoint was defined as death from any cause at a median follow-up duration of 8.1 years (interquartile range: 4.3–11.6 years). RESULTS Among the study patients, 839 patients (47.2%) were treated with statin therapy at enrollment. During the follow-up period, the statin therapy group demonstrated a lower incidence rate of death from any cause (0.67% patient-years vs 1.27% patient-years; adjusted hazard ratio [aHR] ¼ 0.51; 95% confidence interval [CI] ¼ 0.35–0.74; p < 0.001) and a lower incidence rate of cardiac death (0.07% patient-years vs 0.5% patient-years; aHR ¼ 0.10; 95% CI ¼ 0.03–0.32; p < 0.001). In addition, the subgroup analysis according to the severity of concurrent coronary artery disease was consistent with the overall findings: intermediate coronary artery disease (aHR ¼ 0.49; 95% CI ¼ 0.18–1.31; p ¼ 0.15), no or mild coronary artery disease (aHR ¼ 0.65; 95% CI ¼ 0.39–1.08; p ¼ 0.099), and unknown coronary artery disease (aHR ¼ 0.37; 95% CI ¼ 0.19–0.71; p ¼ 0.003).
CONCLUSION Administering statin therapy to patients with VSA is associated with a lower mortality rate during long-term follow-up. Statin therapy should therefore be considered as the standard treatment on top of vasodilator therapy for the treatment of VSA. CATEGORIES CORONARY: Pharmacology/Pharmacotherapy TCT-499 Influence of gender on the clinical characteristics and prognostic factors in patients with vasospastic angina da hyon lee,1 Jeong Hoon Yang,2 Joo Yong Hahn,3 Cláudia Jorge,4 sang hoon lee,5 Fausto J. Pinto,6 Seung-Hyuk Choi7 1 Columbia University Medical Center, seoul, Korea, Republic of; 2 Samsung Medical Center, Seoul, Korea, Republic of; 3Interventional Cardiologist, Seoul, Korea, Republic of; 4Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon; 5Samsung Medical Center, Seoul, Korea, Republic of; 6Cardiology Department, Santa Maria University Hospital, CHLN, CAML, CCUL, Faculty of Medicine, University of Lisbon; 7Samsung Medical Center, Seoul, Korea, Republic of BACKGROUND Men were more likely to suffer vasospastic angina (VSA) than women, but the gender difference in clinical characteristics and prognosis of VSA patients was not fully elucidated. We sought to investigate clinical characteristics and prognostic predictors in both genders of VSA patients. METHODS We included patients with positive result on intracoronary ergonovine provocation test between January 2003 and December 2014. A total of 986 patients were analyzed according to gender (male [n¼838] versus female [n¼148]) for clinical characteristics and major adverse cardiac event (MACE). MACE was defined as a composite outcome of cardiac death, acute myocardial infarction, revascularization, or re-hospitalization due to recurrent angina. RESULTS Female patients were younger and were associated with a lower prevalence of smoking and coronary stenosis, compared with male patients. The risk for MACE was similar between male and female genders (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.65 to 1.39; p ¼ 0.79). In multivariable prediction models for MACE, high-sensitivity CRP (hs-CRP) level was a significant predictor of MACE in male patients (HR, 1.95; 95% CI, 1.25 to 3.06, p ¼ 0.003), while there was no significant predictor of MACE in female patients. There was a significant interaction between hs-CRP level and MACE rate across the gender (interaction p ¼ 0.02).
CONCLUSION Gender related differences in several clinical characteristics were noted in VSA patients. Long-term clinical outcome was not different between both genders, but prognostic predictor differs according to gender. CATEGORIES OTHER: Womens Health Issues