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CLINICAL RESEARCH: CORONARY SPASM

Provoked Coronary Spasm Predicts Adverse Outcome in Patients With Acute Myocardial Infarction

A Novel Predictor of Prognosis After Acute Myocardial Infarction

Kohei Wakabayashi, MD, PhD^_*, Hiroshi Suzuki, MD, PhD^_*,_*, Yuki Honda, MD^_*, Daisuke Wakatsuki, MD^_*, Keisuke Kawachi, MD^_*, Kei Ota, MD^_*, Shinji Koba, MD, PhD, Nobuyuki Shimizu, MD, PhD^_*, Fuyuki Asano, MD, PhD^_*, Tokutada Sato, MD, PhD^_* and Youichi Takeyama, MD, PhD^_*

^_* Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
Third Department of Internal Medicine, Showa University, School of Medicine, Tokyo, Japan.

Manuscript received November 12, 2007; revised manuscript received January 22, 2008, accepted January 27, 2008.

^_* Reprint requests and correspondence: Dr. Hiroshi Suzuki, 1-30 Fujigaoka, Yokohama City, Yokohama 227-8501, Japan. (Email: hrsuzuki{at}med.showa-u.ac.jp).

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.

Key Words: acetylcholine • provoked coronary spasm • acute myocardial infarction • prognosis

Abbreviations and Acronyms   ACh = acetylcholine   ACS = acute coronary syndrome   AMI = acute myocardial infarction   IRA = infarct-related artery   MACE = major adverse cardiac event(s)   PCI = percutaneous coronary intervention   TVR = target vessel revascularization   VSA = vasospastic angina

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