Relation between previously implanted coronary stents and vasospasm: Patient- and vessel-level analysis

Abstract

Background

Catheter-based coronary interventions, particularly those with stent implantation, are associated with arterial wall injury, leading to endothelial dysfunction and vasospasm. However, the impact of previously implanted coronary stents on vasospasm during acetylcholine (ACh) provocation testing remains uncertain.

Methods

From May 2012 to October 2023, a total of 1039 patients underwent intracoronary ACh provocation tests for the diagnosis of vasospastic angina. Patients and coronary vessels were divided into two groups according to the presence of previously implanted coronary stents. Angiographic coronary vasospasm was defined as total or subtotal occlusion induced by ACh injection at the vessel level, and positive diagnosis of ACh testing was defined as angiographic coronary vasospasm accompanied by chest symptoms and/or ischemic electrocardiographic changes at the patient level.

Results

Of the 1039 patients, 175 (16.8 %) had previously implanted coronary stents. The incidence of positive ACh provocation test was significantly higher in patients with previous coronary stents than in those without (60.6 % vs. 52.0 %, P = 0.04). At the vessel-level analysis, intracoronary ACh was administered in the 175 patients with a history of coronary stenting, with coronary arteries with previously implanted coronary stents (n = 236) and no stents (n = 254). ACh-induced angiographic vasospasm was more frequently observed in vessels with coronary stents than in those without (50.0 % vs. 33.3 %, P < 0.001). No significant interactions between bare metal and drug-eluting stents were found in the rate of ACh-induced vasospasm.

Conclusions

Previously implanted stents were associated with coronary vasoreactivity during intracoronary ACh provocation testing at the patient and vessel levels.