Abstract 4140903: Long-Term Clinical Outcomes in Definite versus Intermediate Ergovonine Provocation response in Multivessel Vasospastic Angina Patients

Background: Patients with multivessel coronary spasm showed relatively poor outcomes in vasospastic angina. Recent report also revealed that Ergovonine response definite group showed poor clinical outcomes compared to the Ergovonine response intermediate group. The purpose of this study is to evaluate the clinical impact of Ergovonine provocation definite or intermediate response in multivessel vasospastic angina patients. Methods: A total of 428 patients between May 2010 to November 2013, diagnosed as multivessel vasospastic angina who were registered in the Vasospastic Angina Korea (VA-KOREA) were enrolled. Patients were divided into Ergovonine provocation response definite group (n=111) and intermediate group (n=317). The primary endpoint was cumulative incidece of cardiac death, new onset arrhythmia, acute coronary syndrome, re-admission due to chest pain during 3 years follow-up. Results: In the baseline clinical chracteristics, Ergovonine response definite group had less proportion of male patients (32.4% vs. 49.8%, p=0.002). Other conventional cardiovascular risk factors were similar between two groups. In the angiographic characteristics, electrocardiogram changes during Ergovonine provocation was higher in the deinite group including ST change (18% vs 10.7%; p=0.046), ST elevation (16.2% vs 2.8%; p<0.001), ST depression (7.2% vs 2.5%; p=0.009), induced arrhythmia (27.9% vs 15.5%; p=0.004). Combined atherosclerotic lesion was also higher in the definite group (29.7% vs 15.5%; p=0.001). Prescrpition rate of Calcium channel blocker was lower in the intermediate group compared to the definite group (93.7% vs. 83.6%; p=0.008). The incidence of primary end point was not statistically signficant in both groups (10.8% vs. 14.5%; p=0.327). Multivariative cox regression analysis revealed that Ergovonine provocation response had no significant clinical impact in multivessel vasospastic angina patients (adjusted harzard ratio [HR] 0.64; 95% confidence interval [CI] 0.32 – 1.28; p=0.207). Conclusion: The present study indicates that Ergovonine provocation response is not an independent prognostic factor in multivessel vasospastic angina patients. Thus, intensive medical treatment and risk control should be carried out in both patient groups.