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Sympathectomy versus conventional treatment for refractory coronary artery spasm

Lin, Yaowanga,,*; Liu, Huadonga,,*; Yu, Danqingb; Wu, Meishana; Liu, Qiyuna; Liang, Xinjiana; Pang, Xinlia; Chen, Keqia; Luo, Linjiea; Dong, Shaohong

doi: 10.1097/MCA.0000000000000732
Coronary Spasm
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Background There is no clear consensus on the potential efficacy and indications for sympathectomy to prevent recurrence of vasospasm in patients with refractory coronary artery spasm (CAS).

Objective To compare the clinical outcomes of sympathectomy with those of conventional treatment in patients with refractory CAS.

Patients and methods Patients with refractory CAS were randomly assigned to sympathectomy group (n = 37) or conventional treatment group (n = 42). The primary end point was a composite of major adverse cardiac event (MACE) episodes (including cardiac death, nonfatal myocardial infarction, unstable angina, heart failure, and life-threatening arrhythmia), and the secondary end point was death from any cause within 24 months after randomization.

Results During the follow-up period of 24 months, the incidence of MACE in the sympathectomy and conventional treatment groups was 16.22 and 61.90%, respectively (P = 0.0001). All-cause death as the secondary end point occurred in zero and six (14.29%) patients, respectively (P = 0.0272). The Kaplan–Meier curve for MACE and all-cause death showed a significant between-group difference (log-rank test, P = 0.0013 and 0.0176, respectively).

Conclusion Compared with conventional treatment, sympathectomy significantly reduced the composite end point of MACE episodes and death from any cause in patients with refractory CAS by effectively preventing recurrence of vasospasm.

We conducted a clinical trial to compare the clinical outcomes of sympathectomy with those of conventional treatment in patients with refractory CAS. We found out that sympathectomy significantly reduced the composite endpoint of MACE episodes and death from any cause in patients with refractory CAS by effectively preventing recurrence of vasospasm.

aDepartment of Cardiology, Shenzhen People’s Hospital, 2nd Clinical Medical College of Jinan University, First Affiliated Hospital of South University of Science and Technology, Shenzhen

bDepartment of Cardiology, Guangdong General Hospital, Guangdong Academy of Sciences, Guangzhou, People’s Republic of China

* Yaowang Lin and Huadong Liu contributed equally to the writing of this article.

Received 17 October 2018 Revised 23 January 2019 Accepted 24 February 2019

Correspondence to Shaohong Dong, MD, Department of Cardiology, Shenzhen People’s Hospital, 2nd Clinical Medical College of Jinan University, First Affiliated Hospital of South University of Science and Technology, Shenzhen, Guangdong 518020, People’s Republic of China, Tel: + 86 202 274 3200; fax: + 86 202 274 3200; e-mail: xnkdsh@yeah.net

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