Pharmacological Provocation Test Was Less Frequently Performed in Patients with Coronary Spastic Angina Onset During Coronavirus Disease Pandemic: A Multicenter Cross-sectional Study

Background: The impacts of the coronavirus disease 2019 (COVID-19) pandemic on the diagnostic and therapeutic procedures for patients with coronary spastic angina (CSA) have yet to be elucidated. The present study aimed to investigate whether the COVID-19 pandemic has affected physicians' decision-making regarding the diagnosis and treatment of CSA. Subjects and Methods: Patients who underwent invasive coronary angiography and were diagnosed with CSA between January 2014 and March 2021 at the outpatient clinics of nine hospitals in Kanagawa Prefecture were enrolled in the present study. The patients were divided into two groups: pre-COVID-19 period (between January 1, 2014 and January 31, 2020) and COVID-19 period (between March 1, 2020 and March 31, 2021). We compared the patients' backgrounds and the diagnostic and therapeutic strategies between the two groups. Results: A total of 102 patients with CSA were enrolled in the present study, and there were no significant intergroup differences in patient characteristics. The implementation rate of spasm provocation tests was significantly lower in the COVID-19 than the pre-COVID-19 period group (65% vs. 90%, respectively; P = 0.004), as was the implementation rate of percutaneous coronary intervention (3% vs. 17%, respectively; P = 0.058), despite the similar prevalence of organic coronary stenosis. Conclusion: Pharmacological provocation tests were performed less frequently in patients with CSA during the COVID-19 period than during the pre-COVID-19 period.