IMPACT OF LOW DOSE ASPIRIN ON ACETYLCHOLINE INDUCED

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					  IMPACT OF LOW DOSE ASPIRIN ON ACETYLCHOLINE-INDUCED
 CORONARY ARTERY SPASM AND 12 MONTH CLINICAL OUTCOME
 Ji Young Park, Seung Woon Rha, Kanhaiya L. Poddar, Sureshkumar Ramasamy,
Lin Wang, Byoung Geol Choi, Ji Bak Kim, Seung Yong Shin, Un Jung Choi, Cheol
  Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong
                          Seog Seo, and Dong Joo Oh
                    J. Am. Coll. Cardiol. 2010;55;A47.E452
                      doi:10.1016/S0735-1097(10)60453-6
                This information is current as of March 19, 2012
 The online version of this article, along with updated information and services, is
                        located on the World Wide Web at:
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                                                                                                                                            A47.E452
                                                                                                                                  JACC March 9, 2010
                                                                                                                                 Volume 55, issue 10A

       HYPERTENSION, LIPIDS AND PREVENTION

IMPACT OF LOW DOSE ASPIRIN ON ACETYLCHOLINE-INDUCED CORONARY ARTERY SPASM AND 12
MONTH CLINICAL OUTCOME

ACC Oral Contributions
Georgia World Congress Center, Room B408
Monday, March 15, 2010, 11:30 a.m.-11:45 a.m.


Session Title: Antiplatelet Agents and Coronary Artery Disease
Abstract Category: Pharmacology/Hormones/Lipids—Clinical
Presentation Number: 0908-07


Authors: Ji Young Park, Seung Woon Rha, Kanhaiya L. Poddar, Sureshkumar Ramasamy, Lin Wang, Byoung Geol Choi, Ji Bak Kim, Seung Yong Shin,
Un Jung Choi, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh, Korea University Guro
Hospital, Seoul, South Korea

Background Aspirin is a non-selective COX inhibitor and high dose aspirin can aggravates coronary artery spasm (CAS). However whether low dose
aspirin can similarly impact on coronary spasm is largely unknown. We evaluated the impact of low dose asprin on acetylcholine (Ach) induced
coronary artery spasm (CAS) and 12 month clinical outcome.

Methods A total 1286 consecutive patients without significant coronary artery disease who had taken low dose aspirin (less than 100mg) and
underwent the Ach provocation test by injecting incremental doses of 20, 50, 100 ug into between November 2004 and March 2009.The Ach
provocation test results and 12 clinical outcomes were compared between the Aspirin group (n=287) and non-aspirin group (n=999).

Results The baseline clinical characteristics showed that the classic risk factors including diabetes mellitus (20.6% vs 7.3%, p<0.01), hypertension
(59.3% vs 35.9%, p<0.01), hyperlipidemia (21.6% vs 14.9%, p=0.01) and smoking (34.8% vs 28.5%, p=0.04) were more common in the aspirin
groups. After Ach injection, the rate of positive provocation test result, chest pain, diffuse and severe CAS pattern were more common in the Aspirin
group (Table). Multivariate logistic analysis showed that aspirin itself was an independent risk factor for Ach induced CAS (Adjusted odd ratio; 1.28,
95% confidence interval; 1.01-1.62, p=0.037). 12 month clinical outcomes including death, myocardial infarction (MI) were similiar between two
groups. However, repeat spasm test due to recurrent chest pain was more common in aspirin group (2.8% vs 0.2%, p<0.01).

Conclusion In our study, low dose aspirin was an independent risk factor of Ach induced significant CAS and associated with diffuse spasm and
repeat spasm test due to recurrent chest pain. However,12 month clinical outcome including death and MI was not associated with aspirin. Special
caution should be regarding even low dose aspirin prescription in patients who are suspicious of CAS.

Table. Acetylcholine provocation test results and 12 Clinical outcomes
 Variables, n(%)                            Aspirin group (n=287)                Non-Aspirin group (n=999)             P value
 Ach Provocation (+)                        188 (66.2)                           545 (55.3)                            <0.01*
 Chest pain                                 119 (41.5)                           419 (41.9)                            0.05
 (+) Provocation to Ach dose
 A1 (20μg)                                  11 (3.8)                             38 (3.8)                              1.00
 A2 (50μg)                                  96 (36.0)                            285 (29.7)                            0.05*
 Spasm after Ach injection
                                            156 (54.4)                           456 (45.6)                            <0.01*
 Diffuse
 Severe spasm (>70%)                        94 (49.5)                            269 (48.8)                            <0.01*
 Death                                      1 (0.3)                              1 (0.1)                               0.39
 Myocardial Infarction                      1 (0.3)                              0 (0.0)                               0.23
 Spasm FU d/t recurrent chest pain          8 (2.8)                              2 (0.2)                               <0.01*

                                      Downloaded from content.onlinejacc.org by on March 19, 2012
  IMPACT OF LOW DOSE ASPIRIN ON ACETYLCHOLINE-INDUCED
 CORONARY ARTERY SPASM AND 12 MONTH CLINICAL OUTCOME
 Ji Young Park, Seung Woon Rha, Kanhaiya L. Poddar, Sureshkumar Ramasamy,
Lin Wang, Byoung Geol Choi, Ji Bak Kim, Seung Yong Shin, Un Jung Choi, Cheol
  Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong
                          Seog Seo, and Dong Joo Oh
                    J. Am. Coll. Cardiol. 2010;55;A47.E452
                      doi:10.1016/S0735-1097(10)60453-6
               This information is current as of March 19, 2012

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