Impact of drug-eluting stent-associated coronary artery spasm on 3-year clinical outcomes: A propensity score matching analysis

Jabar Ali, Seung Woon Rha, Byoung Geol Choi, Jae Kyeong Byun, Se Yeon Choi, Jin Ah Cha, Soohyung Park, Kyuho Lee, Seungmin Back, Jieun Lee, Dong Oh Kang, Jah Yeon Choi, Seung Young Roh, Jin Oh Na, Cheol Ung Choi, Jin Won Kim, Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Mohammad WasimZair Hassan

Research output: Contribution to journalArticlepeer-review


Background: It has been reported that significant endothelial dysfunction or clinically evident vasospasm can be associated with drug-eluting stents (DESs). However, the impact of DES associated coronary artery spasm (CAS) on long-term clinical outcomes has not been fully elucidated as compared with those of patients with vasospastic angina. Methods: A total of 2797 consecutive patients without significant coronary artery lesion (<70%), who underwent the Acetylcholine (Ach) provocation test, were enrolled between Nov 2004 and Oct 2010. DES-associated spasm was defined as significant CAS in proximal or distal to previously implanted DES site at follow-up angiography with Ach test. Patients were divided into two groups (DES-CAS; n = 108, CAS; n = 1878). For adjustment, propensity score matching (PSM) was done (C-statistics = 0.766, DES-CAS; n = 102, CAS; n = 102). SPSS 20 (Inc., Chicago, Illinois) was used to analyze this data. Results: Baseline characteristics were worse in the DES-CAS group. After PSM, both baseline characteristics and the Ach test results were balanced except higher incidence of diffuse CAS and ECG change in the DES-CAS group. During Ach test, the incidence of diffuse spasm (93.1% vs. 81.3%, p = 0.012) and ST-T change (10.7% vs. 1.9%, p = 0.010) were higher in the DES-CAS group. At 3-year, before and after adjustment, the DES-CAS group showed a higher incidence of coronary revascularization (9.8% vs. 0.0%, p = 0.001), recurrent chest pain requiring follow up coronary angiography (CAG, 24.5% vs. 7.8%, p = 0.001) and major adverse cardiac events (MACEs, 9.8% vs. 0.9%, p < 0.005). Conclusion: In this study, DES associated CAS was associated with higher incidence of diffuse spasm, ST-T change and adverse 3-year clinical outcomes. Special caution should be exercised in this particular subset of patients.

Original languageEnglish
Pages (from-to)182-186
Number of pages5
JournalIndian Heart Journal
Issue number3
Publication statusPublished - 2022 May 1
Externally publishedYes


  • Ach: acetylcholine
  • CAS
  • Coronary artery spasm
  • DES
  • Drug eluting stents
  • MACE
  • Major adverse cardiac events

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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