Impact of alcohol drinking on acetylcholine-induced coronary artery spasm in Korean populations Sung Min Sohn a, 1 , Byoung Geol Choi b, 1 , Se Yeon Choi b , Jae Kyeong Byun b , Ahmed Mashaly c , Yoonjee Park c , Won Young Jang c , Woohyeun Kim c , Jah Yeon Choi c , Eun Jin Park c , Jin Oh Na c , Cheol Ung Choi c , Hong Euy Lim c , Eung Ju Kim c , Chang Gyu Park c , Hong Seog Seo c , Dong Joo Oh c , Seung-Woon Rha c, * a Department of Medicine, Korea University College of Medicine, South Korea b Department of Medicine, Korea University Graduate School, Seoul, South Korea c Cardiovascular Center, Korea University Guro Hospital, Seoul, South Korea article info Article history: Received 20 July 2017 Received in revised form 24 November 2017 Accepted 30 November 2017 Keywords: Coronary artery spasm Acetylcholine Alcohol Angina abstracts Background and aims: Generally, immoderate alcohol consumption is associated with variant angina and accepted as one of the risk factors for coronary artery spasm (CAS), but evidence is lacking in this regard. The aim of this study is to evaluate the impact of alcohol consumption and drinking pattern on CAS by acetylcholine (ACH) provocation test and long-term clinical outcomes. Methods: A total of 5491 patients with typical or atypical chest pain, without significant coronary artery disease, who underwent intracoronary ACH provocation test, were enrolled prospectively, and retro- spectively analyzed in this study. They were divided into two groups according to their alcohol drinking status; the current alcohol (CA) drinking group (n ¼ 1792), and non-CA group (n ¼ 3699). To adjust for potential confounders, a propensity score matching (PSM) analysis was performed. The primary endpoint was incidence of CAS, and secondary endpoints were major adverse cardiac events (MACE) and recurrent angina requiring repeat coronary angiography (CAG) at 5 years. Results: After PSM analysis, alcohol consumption was a strong risk factor for CAS. Furthermore, excessive alcohol consumption was correlated with a higher risk for CAS. As compared with the non-CA group, the CA group showed worse angiographic and clinical findings, including higher incidence of CAS (58% vs. 62%, p ¼ 0.016), spontaneous spasm (17% vs. 22%, p ¼ 0.004), multi-vessel spasm (31% vs. 37%, p ¼ 0.009), proximal epicardial spasm (39% vs. 46%, p ¼ 0.002), ischemic electrocardiography changes such as T- inversion (0.4% vs. 1.2%, p < 0.001) and chest pain (42% vs. 46%, p ¼ 0.047) during ACH provocation test. However, the status and pattern of alcohol drinking had no influence on long-term clinical outcomes such as MACE or recurrent angina. Conclusions: Alcohol consumption is a strong risk factor for CAS, and excessive alcohol consumption was correlated with a higher risk for CAS. Further well-designed studies are needed to confirm the results. © 2017 Published by Elsevier Ireland Ltd. 1. Introduction Patients who complain of resting chest pain are frequently found to have apparently normal coronary arteries, as seen by the coronary angiography (CAG), and have had no history of gastrointestinal disorders [1,2]. These patients are frequently diagnosed with coronary artery spasm (CAS) by intracoronary provocation test using acetylcholine (ACH) or ergonovine [3e6]. It is well-documented that obstructive CAS, which is closely impli- cated in endothelial dysfunction, can induce acute coronary syn- drome, vasospastic angina (VSA) and even sudden cardiac death [2,6]. Generally, age, smoking, high sensitivity C-reactive protein (hsCRP), remnant lipoproteins, myocardial bridge and insignificant coronary stenosis are well-known significant risk factors for CAS * Corresponding author. Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, South Korea. E-mail address: swrha617@yahoo.co.kr (S.-W. Rha). 1 These authors contributed equally to this work. Contents lists available at ScienceDirect Atherosclerosis journal homepage: www.elsevier.com/locate/atherosclerosis https://doi.org/10.1016/j.atherosclerosis.2017.11.032 0021-9150/© 2017 Published by Elsevier Ireland Ltd. Atherosclerosis 268 (2018) 163e169