OBJECTIVES: 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.
OBJECTIVES: 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: Janet Wei; Puja K Mehta; B Delia Johnson; Bruce Samuels; Saibal Kar; R David Anderson; Babak Azarbal; John Petersen; Barry Sharaf; Eileen Handberg; Chrisandra Shufelt; Kamlesh Kothawade; George Sopko; Amir Lerman; Leslee Shaw; Sheryl F Kelsey; Carl J Pepine; C Noel Bairey Merz Journal: JACC Cardiovasc Interv Date: 2012-06 Impact factor: 11.195
Authors: Rishi Puri; Stephen J Nicholls; Danielle M Brennan; Jordan Andrews; Gary Y Liew; Angelo Carbone; Barbara Copus; Adam J Nelson; Samir R Kapadia; E Murat Tuzcu; John F Beltrame; Stephen G Worthley; Matthew I Worthley Journal: Int J Cardiovasc Imaging Date: 2014-10-09 Impact factor: 2.357