The International Journal of Cardiovascular Imaging

, Volume 34, Issue 11, pp 1697–1706 | Cite as

Clinical efficacy of aspirin with identification of intimal morphology by optical coherence tomography in preventing event recurrence in patients with vasospasm-induced acute coronary syndrome

  • Yonggu Lee
  • Hwan-Cheol Park
  • Jinho Shin
Original Paper


Using optical coherence tomography (OCT), we found that there were morphological differences in the coronary intima between patients with vasospasm-induced acute coronary syndrome (VACS) and those with stable variant angina. We investigated whether aspirin use would protect against chest pain recurrence in patients with VACS. A retrospective cohort study was performed. Patients with ST-segment elevation who were confirmed to have VACS by a provocation test were included. OCT was performed at the index event and when chest pain recurred to assess intimal morphology. Chest pain recurrence was defined as the first revisit to the emergency room with angina. Propensity score matching was performed between the aspirin and non-aspirin groups. For 48 months, 154 patients were followed (77 patients in each group). The baseline characteristics and OCT findings were well balanced between the two groups after propensity score matching. Myocardial infarction (17 vs. 3%, p = 0.003) and chest pain recurrence (26 vs. 9%, p = 0.006) occurred more frequently in the non-aspirin group than in the aspirin group. Multiple Cox regression analysis showed that aspirin use was a significant predictor of lower risk of myocardial infarction [hazard ratio (HR) 0.13; 95% confidence interval (CI) 0.03–0.61] and chest pain recurrence (HR 0.33; 95% CI 0.12–0.71) during the follow-up period, after adjustments for relevant covariates including OCT findings. The use of aspirin may have a preventive effect on myocardial infarction and chest pain recurrence in patients with VACS. Randomized controlled trials are necessary to confirm the result.


Coronary vasospasm Aspirin Optical coherence tomography (OCT) Acute coronary syndrome (ACS) 



We thank Jung-Hun Hu, who collected the baseline data and participated in the processing and analyzing of the OCT images in our center, and Dr. Young-Hyo Lim and Dae-Sung Kim, who helped to process and analyze the OCT images in the core laboratory to validate the OCT results.

Compliance with ethical standards

Conflict of interest

All the authors have no conflicts of interest to declare.

Supplementary material

10554_2018_1399_MOESM1_ESM.docx (2.4 mb)
Supplementary material 1 (DOCX 2420 KB)
10554_2018_1399_MOESM2_ESM.docx (21 kb)
Supplementary material 2 (DOCX 21 KB)


  1. 1.
    Hung MJ, Cheng CW, Yang NI, Hung MY, Cherng WJ (2007) Coronary vasospasm-induced acute coronary syndrome complicated by life-threatening cardiac arrhythmias in patients without hemodynamically significant coronary artery disease. Int J Cardiol 117:37–44CrossRefGoogle Scholar
  2. 2.
    Maseri A, Pesola A, Marzilli M, Severi S, Parodi O, L’Abbate A, Ballestra AM, Maltinti G, De Nes DM, Biagini A (1977) Coronary vasospasm in angina pectoris. Lancet 1:713–717CrossRefGoogle Scholar
  3. 3.
    Bertrand ME, LaBlanche JM, Tilmant PY, Thieuleux FA, Delforge MR, Carre AG, Asseman P, Berzin B, Libersa C, Laurent JM (1982) Frequency of provoked coronary arterial spasm in 1089 consecutive patients undergoing coronary arteriography. Circulation 65:1299–1306CrossRefGoogle Scholar
  4. 4.
    Naghavi M, Libby P, Falk E, Casscells SW, Litovsky S, Rumberger J, Badimon JJ, Stefanadis C, Moreno P, Pasterkamp G, Fayad Z, Stone PH, Waxman S, Raggi P, Madjid M, Zarrabi A, Burke A, Yuan C, Fitzgerald PJ, Siscovick DS, de Korte CL, Aikawa M, Juhani Airaksinen KE, Assmann G, Becker CR, Chesebro JH, Farb A, Galis ZS, Jackson C, Jang IK, Koenig W, Lodder RA, March K, Demirovic J, Navab M, Priori SG, Rekhter MD, Bahr R, Grundy SM, Mehran R, Colombo A, Boerwinkle E, Ballantyne C, Insull W Jr, Schwartz RS, Vogel R, Serruys PW, Hansson GK, Faxon DP, Kaul S, Drexler H, Greenland P, Muller JE, Virmani R, Ridker PM, Zipes DP, Shah PK, Willerson JT (2003) From vulnerable plaque to vulnerable patient: a call for new definitions and risk assessment strategies: Part I. Circulation 108:1664–1672CrossRefGoogle Scholar
  5. 5.
    Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM (2000) Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 20:1262–1275CrossRefGoogle Scholar
  6. 6.
    Shin ES, Ann SH, Singh GB, Lim KH, Yoon HJ, Hur SH, Her AY, Koo BK, Akasaka T (2015) OCT-defined morphological characteristics of coronary artery spasm sites in vasospastic angina. JACC Cardiovasc Imaging 8:1059–1067CrossRefGoogle Scholar
  7. 7.
    Park HC, Shin JH, Jeong WK, Choi SI, Kim SG (2015) Comparison of morphologic findings obtained by optical coherence tomography in acute coronary syndrome caused by vasospasm and chronic stable variant angina. Int J Cardiovasc Imaging 31:229–237CrossRefGoogle Scholar
  8. 8.
    Park HC, Choi SI, Lee JU, Kim SG, Shin J, Kim HJ (2013) Morphological findings in typical variant angina presenting as acute coronary syndrome using optical coherence tomography. J Interv Cardiol 26:491–500CrossRefGoogle Scholar
  9. 9.
    (2014) Guidelines for diagnosis and treatment of patients with vasospastic angina (Coronary Spastic Angina) (JCS 2013). Circ J 78:2779–2801Google Scholar
  10. 10.
    Tearney GJ, Regar E, Akasaka T, Adriaenssens T, Barlis P, Bezerra HG, Bouma B, Bruining N, Cho JM, Chowdhary S, Costa MA, de Silva R, Dijkstra J, Di Mario C, Dudek D, Falk E, Feldman MD, Fitzgerald P, Garcia-Garcia HM, Gonzalo N, Granada JF, Guagliumi G, Holm NR, Honda Y, Ikeno F, Kawasaki M, Kochman J, Koltowski L, Kubo T, Kume T, Kyono H, Lam CC, Lamouche G, Lee DP, Leon MB, Maehara A, Manfrini O, Mintz GS, Mizuno K, Morel MA, Nadkarni S, Okura H, Otake H, Pietrasik A, Prati F, Raber L, Radu MD, Rieber J, Riga M, Rollins A, Rosenberg M, Sirbu V, Serruys PW, Shimada K, Shinke T, Shite J, Siegel E, Sonoda S, Suter M, Takarada S, Tanaka A, Terashima M, Thim T, Uemura S, Ughi GJ, van Beusekom HM, van der Steen AF, van Es GA, van Soest G, Virmani R, Waxman S, Weissman NJ, Weisz G (2012) Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation. J Am Coll Cardiol 59:1058–1072CrossRefGoogle Scholar
  11. 11.
    Wang Z, Jia H, Tian J, Soeda T, Vergallo R, Minami Y, Lee H, Aguirre A, Fujimoto JG, Jang IK (2014) Computer-aided image analysis algorithm to enhance in vivo diagnosis of plaque erosion by intravascular optical coherence tomography. Circ Cardiovasc Imaging 7:805–810CrossRefGoogle Scholar
  12. 12.
    Kim S, Shin DW, Yun JM, Hwang Y, Park SK, Ko YJ, Cho B (2016) Medication adherence and the risk of cardiovascular mortality and hospitalization among patients with newly prescribed antihypertensive medications. Hypertension 67:506–512CrossRefGoogle Scholar
  13. 13.
    Bates ER, Lau WC (2005) Controversies in antiplatelet therapy for patients with cardiovascular disease. Circulation 111:e267-271Google Scholar
  14. 14.
    Miwa K, Kambara H, Kawai C (1981) Exercise-induced angina provoked by aspirin administration in patients with variant angina. Am J Cardiol 47:1210–1214CrossRefGoogle Scholar
  15. 15.
    Kim MC, Ahn Y, Park KH, Sim DS, Yoon NS, Yoon HJ, Kim KH, Hong YJ, Park HW, Kim JH, Jeong MH, Cho JG, Park JC, Kang JC (2013) Clinical outcomes of low-dose aspirin administration in patients with variant angina pectoris. Int J Cardiol 167:2333–2334CrossRefGoogle Scholar
  16. 16.
    Lim AY, Park TK, Cho SW, Oh MS, Lee da H, Seong CS, Gwag HB, Yang JH, Song YB, Hahn JY, Choi JH, Lee SH, Gwon HC, Ahn J, Carriere KC, Choi SH (2016) Clinical implications of low-dose aspirin on vasospastic angina patients without significant coronary artery stenosis; a propensity score-matched analysis. Int J Cardiol 221:161–166CrossRefGoogle Scholar
  17. 17.
    Park JY, Rha SW, Poddar KL, Ramasamy S, Chen KY, Li YJ, Choi BG, Ryu SK, Choi JW, Park SH, Park S, Elnagar A, Im SI, Kim SW, Na JO, Choi CU, Lim HE, Kim JW, Kim EJ, Han SW, Park CG, Seo HS, Oh DJ (2012) Impact of low-dose aspirin on coronary artery spasm as assessed by intracoronary acetylcholine provocation test in Korean patients. J Cardiol 60:187–191CrossRefGoogle Scholar
  18. 18.
    Husain S, Andrews NP, Mulcahy D, Panza JA, Quyyumi AA (1998) Aspirin improves endothelial dysfunction in atherosclerosis. Circulation 97:716–720CrossRefGoogle Scholar
  19. 19.
    Ong P, Athanasiadis A, Borgulya G, Vokshi I, Bastiaenen R, Kubik S, Hill S, Schaufele T, Mahrholdt H, Kaski JC, Sechtem U (2014) Clinical usefulness, angiographic characteristics, and safety evaluation of intracoronary acetylcholine provocation testing among 921 consecutive white patients with unobstructed coronary arteries. Circulation 129:1723–1730CrossRefGoogle Scholar
  20. 20.
    Onaka H, Hirota Y, Shimada S, Kita Y, Sakai Y, Kawakami Y, Suzuki S, Kawamura K (1996) Clinical observation of spontaneous anginal attacks and multivessel spasm in variant angina pectoris with normal coronary arteries: evaluation by 24-hour 12-lead electrocardiography with computer analysis. J Am Coll Cardiol 27:38–44CrossRefGoogle Scholar
  21. 21.
    Lanza GA, Sestito A, Sgueglia GA, Infusino F, Manolfi M, Crea F, Maseri A (2007) Current clinical features, diagnostic assessment and prognostic determinants of patients with variant angina. Int J Cardiol 118:41–47CrossRefGoogle Scholar
  22. 22.
    Morikawa Y, Uemura S, Ishigami K, Soeda T, Okayama S, Takemoto Y, Onoue K, Somekawa S, Nishida T, Takeda Y, Kawata H, Horii M, Saito Y (2011) Morphological features of coronary arteries in patients with coronary spastic angina: assessment with intracoronary optical coherence tomography. Int J Cardiol 146:334–340CrossRefGoogle Scholar
  23. 23.
    Tanaka A, Shimada K, Tearney GJ, Kitabata H, Taguchi H, Fukuda S, Kashiwagi M, Kubo T, Takarada S, Hirata K, Mizukoshi M, Yoshikawa J, Bouma BE, Akasaka T (2011) Conformational change in coronary artery structure assessed by optical coherence tomography in patients with vasospastic angina. J Am Coll Cardiol 58:1608–1613CrossRefGoogle Scholar

Copyright information

© Springer Nature B.V. 2018

Authors and Affiliations

  1. 1.Department of Cardiology, Hanyang University Guri HospitalHanyang University, College of MedicineGuriSouth Korea
  2. 2.Department of Cardiology, Hanyang University Seoul HospitalHanyang University, College of MedicineSeoulSouth Korea

Personalised recommendations