Clinical Report : Survey of Coronary Spasm in Japan Before the Establishment of Spasm Guideline: Analysis of Questionnaires in All Japan Shozo Akira Yousuke Hiroaki Hiroshi SUEDA, MD,FJCC OSHITA, MD IZOE, MD KOHNO, MD FUKUDA, MD Key Words Coronary vasospasm guideline, Japan Angina pectoris 3 1 10 11 15 2006 877 3001,177 2006 1 42 1 13 14 19 20 2829 31 32 3637 42 4 17.7% 208/1,177 17.4% 12/6923.1% 18/7820.3% : 793 0027 269 1 Department of Cardiology, Saiseikai Saijo Hospital, Ehime Address for correspondence : SUEDA S, MD, FJCC, Department of Cardiology, Saiseikai Saijo Hospital, Tsuitachi 269 1, Saijo, Ehime 793 0027; E-mail: EZF03146@nifty.com Manuscript received June 13, 2006; revised July 22, 2006; accepted August 16, 2006 333
334 57/281 21.1% 12/57 11.1% 17/15314.7% 34/231 21.1% 30/142 16.9% 28/166 146 61 101 149 45 31 208 1 1 64% 28% 2% 0% Dose of ACh in the RCAg 20// 80 20/ 10/20 30 / 25/ 20//100 12.5/25/ 20// 80/100 5/15/ 20/ 5/10/20/ 20/ 10/20 10/20/30 45 100 Table 1 Dose of acetylcholine Dose of ACh in the LCAg 20//100 /100 10 /20//100 25 //100 100 /100 20 //100 12.5/25// 100 20/ /100/ 1 10/30/100 5/10/20//100 30/60/100 20/30/ 90 100 6/60 Number % 59 44.7 14 10.6 14 10.6 9 6.8 7 5.3 6 4.5 4 3.0 4 3.0 3 2.3 3 2.3 2 1.5 ACh acetylcholine ; R L CA right left coronary artery. 2 47% 27% 19% 3 53% 15% 8% 4 44% 23% 14% 9% 2% Table 2 Administration time of acetylcholine Administration time Number % 10 sec 16 12.1 20 30 sec 103 78.0 60 sec 11 8.3 120 sec 180 sec 5 62% 16% 13% 6 Tables 1, 2 7 Tables 3, 4 J Cardiol 2006 Dec; 48 6 : 333 343
335 Dose of ER in the RCAg 20/ 20 1/5 /10/20/ 30/40 20/ 40 30 60 20 25/ 15 30 5/15 30/ 15/25 10/30/ 4/8/16 2.5/10 25/75 20 4/16 10 80 Table 4 Administration time of ergonovine Administration time Table 3 Dose of ergonovine Dose of ER in the LCAg 20/ 20 1/5 /10/20/ 30/40 20/40/ 60/80 40 64 20 25//100 125 24 40 5/15/ 30/ 10/20/30 10/30/ 6/12/24 5/15/30 /100 320 28 10/20 80 ER ergonovine. Other abbreviations as in Table 1. Number % 7 13.2 4 7.5 11 20.8 4 7.5 9 17.0 2 3.8 5 9.4 Number % 8 44% 39% 9 Fig. 1 10 52% 24% 10% 11 37% 36% 12 Fig. 2 13 32% 29% 14% Fig. 1 Complications of acetylcholine spasm provocation tests VF ventricular fibrillation ; VT ventricular tachycardia; AMI acute myocardial infarction ; TIA transient ischemic attack; EMD electromechanical dissociation.
336 Fig. 2 Complications of ergonovine spasm provocation tests C AV block complete atrioventricular block ; Res respirator ; IABP intraaortic balloon pumping. Other abbreviations as in Fig. 1. 2 14 32% 90% 25% 12% 75% 15 16% 90% 14% 14% 75% 18 69% 48% 46% 75% 14% 75% 19 Fig. 3 16 49% 28% 10% 8% 17 52% 32% 6% 3% 3 20 71% 21% 1% 21 2 72% 52% 2 42% J Cardiol 2006 Dec; 48 6 : 333 343
337 23 62% 36% 24 Fig. 4 H 2 1 25 53% 44% 10% 9% 7% 1% Fig. 3 Definition of positive spasm in each hospital AHA American Heart Association; CAG coronary angiography ; EDP end-diastolic pressure ; LVG left ventriculography ; GERD gastroesophageal reflux disease ; CS coronary sinus. Other abbreviation as in Table 1. 26 62% 30% 1% 27% 22 1 37% 36% 30% 27 70% 21% 2% 28
338 Fig. 4 Efficacy of drugs in patients with refractory coronary spastic angina Ca calcium; ACE-I angiotensin converting enzyme inhibitor; ARB angiotensin receptor blocker; Mg magnesium. 76% 33% 15% 2% 4 29 52% 20% 14% 30 46% 37% 26% Treadmill 24% 6% 31 31% 28% 16% 21% BMIPP 13% MIBG 8% Tl 1% MIBI 5 32 42% 32% 23% 33 73% 18% 5% J Cardiol 2006 Dec; 48 6 : 333 343
339 34 73% 16% 14% 35 55% 40% 100% 0% 41 74% 14% 8% 36 35% 13% Statin 8% Intervention 7% ACE-I/ARB 6 37 61% 38% 1% 38 43% 26% 23% 39 51% 21% 14% 3% 2% 40 42 Fig. 5 1 16 Fig. 5 Comments of questionnaire of coronary spasm DC direct-current countershock ; PCPS percutaneous cardiopulmonary support ; DCM dilated cardiomyopathy ; HCM hypertrophic cardiomyopathy ; HHD hypertensive heart disease. Other abbreviations as in Fig. 2.
340 17,18 20 30 1 Tables 1, 2 Tables 3, 4 2/3 Figs. 1, 2 71% 76% 4 46% 2 99% 25% 90% 32% 75% 12% 99% 14% 90% 16% 75% 14% 49% Fig. 3 3 62% Fig. 4 53% 44% 9% 5 73% 42% 23% 2 38% 19 55% 35% 20,21 6 38% 51% 37% 74% J Cardiol 2006 Dec; 48 6 : 333 343
341 8% 14% Fig. 5 17.7% 22 3 5 17-2 : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : JA
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