title: Provoked coronary spasm predicts adverse outcome in patients with acute myocardial infarction: a novel predictor of prognosis after acute myocardial infarction.
abstract: 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.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
authors.forename: Kohei
authors.initials: K
authors.lastname: Wakabayashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Suzuki
authors.forename: Yuki
authors.initials: Y
authors.lastname: Honda
authors.forename: Daisuke
authors.initials: D
authors.lastname: Wakatsuki
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kawachi
authors.forename: Kei
authors.initials: K
authors.lastname: Ota
authors.forename: Shinji
authors.initials: S
authors.lastname: Koba
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Shimizu
authors.forename: Fuyuki
authors.initials: F
authors.lastname: Asano
authors.forename: Tokutada
authors.initials: T
authors.lastname: Sato
authors.forename: Youichi
authors.initials: Y
authors.lastname: Takeyama
mesh_terms: 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
chemical_list: D000109:Acetylcholine