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Korean Circ J. 2016 Sep;46(5):632-638. Epub 2016 Sep 28.

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

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Department of Medicine, Korea University Graduate School, Seoul, Korea.
Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea.
Department of General Internal Medicine, Weiss Memorial Hospital, Chicago, IL, USA.
Department of Cardiology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea.
Cardiovascular Center, Eulji University, Eulji General Hospital, Seoul, Korea.
Cardiovascular Center, Chungju Kunkuk University, Chungju, Korea.
Cardiovascular Center, Seonam University, Myongji Hospital, Goyang, Korea.



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.


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.


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).


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.


Cigarette smoking; Clinical outcome; Coronary artery spasm

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