Shaopeng Xu

Five-year clinical outcomes in patients with significant coronary artery spasm: A propensity score-matched analysis

BACKGROUND Coronary artery spasm (CAS) is known to be a risk factor of acute coronary syndrome and angina pectoris. However, there is no currently available data with larger study population regarding long-term clinical outcomes of CAS in real world clinical practice. OBJECTIVES We evaluated the prevalence of CAS and the impact of CAS on 5-year clinical outcomes in a series of Asian CAS patients documented by intracoronary acetylcholine (Ach) provocation test. METHODS A total of 1413 consecutive patients without significant coronary artery disease (CAD) who underwent Ach provocation test between Nov. 2004 and Oct. 2008 were enrolled. Significant CAS was defined as >70% of narrowing by incremental intracoronary injection of 20, 50 and 100 μg. Patients were divided into two groups based on the presence of significant CAS (the non-CAS group: n=640, the CAS group; n=773). To adjust potential confounders, a propensity score matched (PSM) analysis was performed using the logistic regression model. RESULTS A total of 54.7% (773/1413) patients were diagnosed as CAS documented by Ach provocation test. After PSM analysis, 2 propensity-matched groups (451 pairs, n=902, C-statistic=0.677) were generated. Despite of similar incidence of individual hard endpoints including mortality, myocardial infarction and revascularization, the CAS group showed the higher trend of recurrent angina requiring follow up angiography than the non-CAS group up to 5 years (HR; 1.56, 95% C.I.; 0.99-2.46, p=0.054). CONCLUSIONS The prevalence of CAS was 54.7%. Although the cumulative incidence of recurrent angina requiring follow up coronary angiography seems to be increased up to 5 years in CAS patients, CAS patients was not associated with major individual and composite clinical outcomes such as mortality, MI, PCI, CVA with optimal medical therapy as compared with patients without CAS.

Impact of low dose atorvastatin on development of new-onset diabetes mellitus in Asian population: Three-year clinical outcomes

BACKGROUND High dose atorvastatin is known to be associated with new onset diabetes mellitus (NODM) in patients with high risk for developing diabetes mellitus (DM). However, low dose atorvastatin is more commonly used as compared with high dose atorvastatin. The aim of this study is to investigate the impact of low dose atorvastatin (LDA, 10mg or 20mg) on the development of NODM up to three years in Asian patients. METHODS From January 2004 to September 2009, we investigated a total of 3566 patients who did not have DM. To adjust for potential confounders, a propensity score matching (PSM) analysis was performed using the logistic regression model. After PSM (C-statistics: 0.851), a total of 818 patients (LDA group, n=409 patients and control group, n=409 patients) were enrolled for analysis. RESULTS Before PSM, the cumulative incidence of NODM (5.8% vs. 2.1%, p<0.001), myocardial infarction (0.5% vs. 0.1%, p-value=0.007), and major adverse cardio-cerebral event (MACCE, 1.8% vs. 0.7%, p-value=0.012) at three-years were higher in the LAD group. However, after PSM, there was a trend toward higher incidence of NODM (5.9% vs. 3.2%, p=0.064) in the LDA group, but the incidence of MACCE (1.2% vs. 1.5%, p-value=1.000) was similar between the two groups. In multivariable analysis, the LDA administration was tended to be an independent predictor of NODM (OR: 1.99, 95% CI: 1.00-3.98, p-value 0.050). CONCLUSIONS In this study, the use of LDA tended to be a risk factor for NODM in Asian patients and reduced clinical events similar to the control group. However, large-scale randomized controlled trials will be needed to get the final conclusion.

Impact of Cigarette Smoking: a 3-Year Clinical Outcome of Vasospastic Angina Patients

Background and Objectives Cigarette smoking is a risk significant factor in coronary artery disease (CAD) and vasospastic angina (VSA). However, it is largely unknown whether smoking adds to any long-term clinical risk in VSA patients. Subjects and Methods A total of 2797 patients without significant CAD underwent acetylcholine (Ach) provocation test between November 2004 and October 2010. Patients were divided into three groups, based on the presence of coronary artery spasm (CAS) and smoking habits (non-CAS group: n=1188, non-smoking CAS group: n=1214, smoking CAS group: n=395). All CAS patients were prescribed with anti-anginal medications for at least 6 months. The incidence of major clinical outcomes and recurrent angina of these groups were compared up to 3 years. Results There were considerable differences in the baseline clinical and angiographic characteristics among the three groups, but there was no difference in the endpoints among the three groups (including individual and composite hard endpoints) such as death, myocardial infarction, de novo percutaneous coronary intervention, cerebrovascular accident, and major adverse cardiac events. However, there was a higher incidence of recurrent angina in both the non-smoking CAS group and smoking CAS group, as compared to the non-CAS group. In multivariable adjusted Cox-proportional hazards regression analysis, smoking CAS group exhibited a higher incidence of recurrent angina compared with the non-CAS group (hazard ratio [HR]; 2.46, 95% confidence interval [CI]; 1.46-4.14, p=0.001) and non-smoking CAS group (HR; 1.76, 95% CI; 1.08-2.87, p=0.021). Conclusion Cigarette smoking CAS group exhibited higher incidence of recurrent angina during the 3-year clinical follow-up compared with both the non-CAS group and non-smoking CAS group. Quitting of smoking, paired with intensive medical therapy and close clinical follow-up, can help to prevent recurrent angina.

Single Catheter Usage for Both Left and Right Coronary Arteries

Transradial bilateral coronary angiography and angioplasty by single catheter is a useful technique but not a new one [1]. Since 1996, it has been reported that transradial percutaneous transluminal coronary angioplasty (PTCA) can be performed by single Kimny guiding catheter in single procedure [2]. Kiemeneij [3] reported several total coronary occlusion cases treated with single guiding catheter by simultaneous transradial coronary angioplasty and contralateral coronary angiography. The most remarkable characteristic is its ability of reducing the transradial intervention (TRI) related complications. Nowadays, transradial approach has been taken as the alternative of transfemoral access or the preferred access for percutaneous coronary intervention (PCI), given that transradial approach is known as being associated with lower vascular complication rates, improved patient comfort, and lower procedural costs than the femoral approach [4]. However the TRI related complications such as radial artery spasm is still worried by operators. Single catheter technique may amplify the priority of TRI buy reducing radial artery spasm because it does not need separate catheter for both left and right coronary arteries. Compared with conventional TRI, the advantages of single catheter for bilateral coronary artery intervention includes lower costs, reduction of vascular complications such as radial artery spasm, dissection, occlusion, perforation, reduction of radiation exposure, reduction of procedure time, and reduction of contrast volume.

COMPARISON OF PLATINUM CHROMIUM ALLOY AND COBALT CHROMIUM ALLOY EVEROLIMUS-ELUTING STENT IN PATIENTS WITH DE NOVO CORONARY ARTERY LESION: A PROPENSITY SCORE-MATCHED ANALYSIS

There are limited data comparing the safety and efficacy of newer generation Platinum Chromium Everolimus-eluting Stent (PtCr-EES, Promus ElementTM, Boston Scientific) with Cobalt Chromium EES (CoCr-EES, PromusTM, Boston Scientific and XienceTM, Abbott Vascular) in a series of Asian population. A

THREE-YEAR CLINICAL OUTCOME COMPARISON BETWEEN EVEROLIMUS- VERSUS ZOTAROLIMUS-ELUTING STENTS IN ALL-COMERS AND DIABETICS

TCTAP A-057 Three-Year Clinical Outcome Comparison Between Everolimus-Versus Zotarolimus-Eluting Stents in All-Comers and Diabetics Shaopeng Xu, Seung-Woon Rha, Byoung Geol Choi, Se Yeon Choi, Jabar Ali, Harris Ngow, Ji Bak Kim, Cheol Ung Choi, Eung Ju Kim, Dong Joo Oh Tianjin General Hospital, China; Korea University Guro Hospital, Korea (Republic of); Korea University Guro Hospital, Pakistan; Hospital Tengku Ampuan Afzan, Malaysia

IMPACT OF DIABETES MELLITUS ON 5-YEAR CLINICAL OUTCOMES IN PATIENTS WITH SIGNIFICANT CORONARY ARTERY SPASM: A PROPENSITY SCORE MATCHING STUDY

Diabetes mellitus (DM) is known to be a risk factor of significant coronary artery disease (CAD). However, there is no currently available data with larger study population regarding long-term clinical outcomes of DM with CAS in real world clinical practice, particularly in a series of Korean