Provoked coronary spasm predicts adverse outcome in patients with acute myocardial infarction: a novel predictor of prognosis after acute myocardial infarction.
OBJECTIVE
This study was conducted to examine the relationship between provoked coronary spasm and clinical course in patients with acute myocardial infarction (AMI).


BACKGROUND
Coronary spasm has a pathogenetic role in the occurrence of AMI and progressive atherosclerosis. There is no report that focused on the prognostic significance of provoked coronary spasm in AMI patients.


METHODS
Our group investigated 240 consecutive patients who underwent spasm-provocation tests using acetylcholine after AMI. Coronary spasm was defined as a transient total or subtotal occlusion of the luminal diameter. The patients were divided into 2 groups (positive group: n = 174, negative group: n = 66).


RESULTS
The clinical courses of the 2 groups were compared at long-term follow up (mean, 43 months). Major adverse cardiac events (death, acute coronary syndrome, or revascularization) occurred in 82 patients (47.1%) in the positive group and 18 patients (27.3%) in the negative group (p = 0.0055). The frequency of major adverse cardiac event-free survival was significantly lower in the positive group than in the negative group (p = 0.0018). Provoked coronary spasm was a significant independent predictor of poor prognosis.


CONCLUSIONS
Provoked coronary spasm predicts adverse outcome in AMI patients.
Wakabayashi
Kohei
K
Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
Suzuki
Hiroshi
H
Honda
Yuki
Y
Wakatsuki
Daisuke
D
Kawachi
Keisuke
K
Ota
Kei
K
Koba
Shinji
S
Shimizu
Nobuyuki
N
Asano
Fuyuki
F
Sato
Tokutada
T
Takeyama
Youichi
Y
D000109:Acetylcholine; D054058:Acute Coronary Syndrome / Q000209:etiology; D000368:Aged; D000787:Angina Pectoris / Q000209:etiology; D015906:Angioplasty, Balloon, Coronary; D003329:Coronary Vasospasm / Q000139:chemically induced / Q000150:complications / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
D000109:Acetylcholine