Five-year clinical outcomes of patients with coronary artery spasm-induced acute myocardial infarction

초록

Introduction: Although the prognosis of coronary artery spasm (CAS) is known to be good, but CAS can evoke acute myocardial infarction (AMI) even in patients (pts) without culprit lesion. However, there is a paucity of data regarding the long-term clinical outcomes of pts with CAS induced AMI. The purpose of this study was to investigate the prognosis of the AMI pts without culprit lesion and confirmed CAS by Acetylcholine (Ach) provocation test. Methods: A total of 3,360 consecutive pts who were diagnosed CAS and without significant coronary lesion were retrospectively identified. AMI was an initial presentation in 34 patients (CAS MI group), and not in other 3326 pts (CAS group). The clinical outcomes up to 5 years were compared between the two groups. Results: Baseline characteristics and cardiovascular risk factors did not differ significantly between the two groups. And there was no significant difference in angiographic parameters including spasm location, extent, length and severity of spams during Ach provocation test between the two groups. However, the cumulative incidence of recurrent angina[HR; 2.71 (95% CI; 1.20–6.13), p=0.016], de novo myocardial infarction[MI, HR; 33.89 (95% CI; 8.76–131.1), p<0.001] and major cardiovascular adverse events[MACEs HR; 10.94 (95% CI; 3.83–31.22), p<0.001] up to 5 years were significantly higher in the CAS MI group on a multivariate analysis including cardiovascular risk factors (Fig).