Does the intracoronary pressure differ according to two types (diffuse or focal) of coronary spasm?

Table 1 Patients characteristics

	Group D	Group F	P value
No. (%)	54 (62)	33 (38)
Age (yr)	65 ± 11	69 ± 10	0.06
Male/Female	28/26	22/11	0.18
BMI (kg/m2)	24.4 ± 4.2	24.7 ± 3.4	0.77
Coronary risk factors (%)
Current smoker	11 (20)	8 (24)	0.67
Hypertension	34 (63)	27 (82)	0.06
Dyslipidemia	36 (67)	19 (58)	0.39
Diabetes mellitus	10 (19)	9 (27)	0.34
Family history of CAD (%)	12 (22)	8 (24)	0.83
MtS (%)	12 (22)	14 (42)	0.04
CKD (%)	16 (30)	13 (39)	0.35

BMI: Body mass index; CAD: Coronary artery disease; CKD: Chronic kidney disease; D: Diffuse; F: Focal; MtS: Metabolic syndrome; No.: Number.

Table 2 The results of blood chemical and echographic parameters in the 2 groups

	Group D	Group F	P value
Blood chemical parameters
Total cholesterol (mg/dL)	193 ± 33	202 ± 40	0.26
Triglyceride (mg/dL)	142 ± 76	143 ± 58	0.93
HDL-cholesterol (mg/dL)	57 ± 17	57 ± 17	0.99
LDL-cholesterol (mg/dL)	107 ± 25	116 ± 32	0.16
Fasting blood sugar (mg/dL)	103 ± 30	107 ± 15	0.53
Hemoglobin A1c (%)	5.8 ± 0.9	6.1 ± 0.8	0.18
C-reactive protein (mg/dL)	0.06 (0.04, 0.18)	0.07 (0.02, 0.17)	0.74
Brain natriuretic peptide (pg/mL)	16 (10, 35)	20 (10, 30)	0.92
eGFR (mL/min/1.73 m2)	70.7 ± 14.5	67.8 ± 14.8	0.37
Echographic parameters
LVEF on UCG (%)	66 ± 9	67 ± 6	0.61
FMD on brachial ultrasonography (%)	3.9 ± 2.8 (n = 47)	2.8 ± 3.3 (n = 33)	0.11
NID on brachial ultrasonography (%)	15.2 ± 7.5 (n = 47)	12.3 ± 5.2 (n = 33)	0.05

D: Diffuse; eGFR: Estimated glomerular filtration ratio; F: Focal; FMD: Flow-mediated dilation; HDL: High-density lipoprotein; LDL: Low-density lipoprotein; LVEF: Left ventricular ejection fraction; NID: Nitroglycerin-induced dilation; UCG: Cardiac ultrasonography.

Table 3 The results of VSA-related parameters in the 2 groups

	Group D	Group F	P value
Medications taken before CAG
Calcium-channel blocker (%)	11 (20)	16 (48)	0.01
Long-acting nitrate (%)	6 (11)	9 (27)	0.05
Statins (%)	26 (48)	9 (27)	0.05
Anti-platelet therapy (%)	14 (26)	9 (27)	0.89
VSA-related symptom
Cold sweating or syncope (%)	5 (9)	4 (12)	0.67
CAG.SPT
Coronary atherosclerosis (%)	28 (52)	25 (76)	0.03
MB (%)	7 (13)	10 (30)	0.05
Multi-vessel spasm (%, n)	32 (74, 43)	19 (66, 29)	0.42

CAG: Coronary angiography; D: Diffuse; F: Focal; MB: Myocardial bridging; SPT: Spasm provocation test; VSA: Vasospastic angina.

Table 4 Lesional characteristics in the diffuse and focal spasms

	Diffuse spasm	Focal spasm	P value
No.	100	34
ST elevation on ECG during SPT	6 (6)	13 (35)	< 0.01
Total or subtotal occlusion on CAG	9 (9)	9 (26)	0.02
Spastic vessels: RCA/LAD	46/54	13/21	0.43
Spasm site
Proximal/Mid/Distal	12/57/31	5/16/13	0.58
Dose of ACh at spasm provocation
Low (%)/Moderate (%)/High (%)	32 (32)/65 (65)/3 (3)	13 (38)/16 (47)/5 (15)	0.03
Intracoronary pressure indexes
Baseline Pd/Pa	0.96 ± 0.05	0.95 ± 0.05	0.35
Minimal Pd/Pa	0.77 ± 0.11	0.66 ± 0.20	< 0.01
ΔPd/Pa	- 0.19 ± 0.11	- 0.29 ± 0.20	< 0.01
iFR (n)	0.96 ± 0.07 (n = 52)	0.95 ± 0.08 (n = 17)	0.83
FFR (n)	0.85 ± 0.08 (n = 26)	0.80 ± 0.10 (n = 8)	0.18

ACh: Acetylcholine; CAG: Coronary angiography; ECG: Electrocardiogram; FFR: Fractional flow reserve; iFR: Instantaneous free-wave ratio; LAD: Left anterior descending coronary artery; No.: Number; Pd: Distal pressure; Pa: Aortic pressure; RCA: Right coronary artery; SPT: Spasm provocation test.

Table 5 Multivessel regression analysis for Δdistal pressure/aortic pressure during spasm provocation test

Factors	F value	P value
Focal spasm	14.14	< 0.01
Atherosclerosis	1.38	0.24
ACh dose at spasm provocation	1.08	0.34
R2 = 0.18

ACh: Acetylcholine.