Clinical characteristics and outcomes of patients with coronary artery spasm who initially presented with acute myocardial infarction

Ji Bak Kim, Byoung Geol Choi, Seung-Woon Rha, Hong Seog Seo, Se Yeon Choi, Jae Kyeong Byun, Jin Oh Na, Cheol Ung Choi, Eung Ju Kim, Chang Gyu Park, Dong Joo Oh

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Background The long-term clinical outcomes of coronary artery spasm (CAS) patients presented with acute myocardial infarction (AMI) compared to those who did not present with AMI has rarely been investigated. Methods From November 2004 to May 2014, a total of 3360 patients who were confirmed as CAS by the acetylcholine (Ach) provocation test and without significant coronary lesion were retrospectively analyzed. AMI was an initial presentation in 34 patients [CAS-myocardial infarction (MI) group], and not in other 3326 patients (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 between the two groups, except the higher smoking rate in CAS-MI group (38.2 vs. 23.5%, P=0.046). During a mean follow-up period of 1211±583 days, the cumulative incidence of recurrent angina [hazard ratio (HR): 2.71; 95% confidence interval (CI): 1.20-6.13; P=0.016], MI (HR: 33.89; 95% CI: 8.76-131.1; P<0.001) and major adverse cardiovascular events (MACE; HR: 10.94; 95% CI: 3.83-31.22; P<0.001) were significantly higher in the CAS-MI group. After propensity score matched analysis (1: 5 matching; n=186, C-statistic=0.834), the incidences of recurrent angina (HR; 4.68; 95% CI: 1.62-13.5; P=0.004) and MACE (HR: 12.2; 95% CI: 2.23-67.3; P=0.003) remained higher in the CAS-MI group. Conclusion The CAS-MI group patients were associated with higher incidence of recurrent angina, MI, and MACE compared to CAS group patients. More intensive antispastic medication might be needed for these patients, and further study will be necessary to determine which treatment can improve the prognosis of CAS-MI patients.

Original languageEnglish
Pages (from-to)60-67
Number of pages8
JournalCoronary Artery Disease
Volume29
Issue number1
DOIs
Publication statusPublished - 2018 Jan 1

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Spasm
Coronary Vessels
Myocardial Infarction
Confidence Intervals
Incidence
Propensity Score
Acetylcholine
Smoking

Keywords

  • clinical outcomes
  • coronary artery spasm
  • myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Clinical characteristics and outcomes of patients with coronary artery spasm who initially presented with acute myocardial infarction. / Kim, Ji Bak; Choi, Byoung Geol; Rha, Seung-Woon; Seo, Hong Seog; Choi, Se Yeon; Byun, Jae Kyeong; Na, Jin Oh; Choi, Cheol Ung; Kim, Eung Ju; Park, Chang Gyu; Oh, Dong Joo.

In: Coronary Artery Disease, Vol. 29, No. 1, 01.01.2018, p. 60-67.

Research output: Contribution to journalArticle

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abstract = "Background The long-term clinical outcomes of coronary artery spasm (CAS) patients presented with acute myocardial infarction (AMI) compared to those who did not present with AMI has rarely been investigated. Methods From November 2004 to May 2014, a total of 3360 patients who were confirmed as CAS by the acetylcholine (Ach) provocation test and without significant coronary lesion were retrospectively analyzed. AMI was an initial presentation in 34 patients [CAS-myocardial infarction (MI) group], and not in other 3326 patients (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 between the two groups, except the higher smoking rate in CAS-MI group (38.2 vs. 23.5{\%}, P=0.046). During a mean follow-up period of 1211±583 days, the cumulative incidence of recurrent angina [hazard ratio (HR): 2.71; 95{\%} confidence interval (CI): 1.20-6.13; P=0.016], MI (HR: 33.89; 95{\%} CI: 8.76-131.1; P<0.001) and major adverse cardiovascular events (MACE; HR: 10.94; 95{\%} CI: 3.83-31.22; P<0.001) were significantly higher in the CAS-MI group. After propensity score matched analysis (1: 5 matching; n=186, C-statistic=0.834), the incidences of recurrent angina (HR; 4.68; 95{\%} CI: 1.62-13.5; P=0.004) and MACE (HR: 12.2; 95{\%} CI: 2.23-67.3; P=0.003) remained higher in the CAS-MI group. Conclusion The CAS-MI group patients were associated with higher incidence of recurrent angina, MI, and MACE compared to CAS group patients. More intensive antispastic medication might be needed for these patients, and further study will be necessary to determine which treatment can improve the prognosis of CAS-MI patients.",
keywords = "clinical outcomes, coronary artery spasm, myocardial infarction",
author = "Kim, {Ji Bak} and Choi, {Byoung Geol} and Seung-Woon Rha and Seo, {Hong Seog} and Choi, {Se Yeon} and Byun, {Jae Kyeong} and Na, {Jin Oh} and Choi, {Cheol Ung} and Kim, {Eung Ju} and Park, {Chang Gyu} and Oh, {Dong Joo}",
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T1 - Clinical characteristics and outcomes of patients with coronary artery spasm who initially presented with acute myocardial infarction

AU - Kim, Ji Bak

AU - Choi, Byoung Geol

AU - Rha, Seung-Woon

AU - Seo, Hong Seog

AU - Choi, Se Yeon

AU - Byun, Jae Kyeong

AU - Na, Jin Oh

AU - Choi, Cheol Ung

AU - Kim, Eung Ju

AU - Park, Chang Gyu

AU - Oh, Dong Joo

PY - 2018/1/1

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N2 - Background The long-term clinical outcomes of coronary artery spasm (CAS) patients presented with acute myocardial infarction (AMI) compared to those who did not present with AMI has rarely been investigated. Methods From November 2004 to May 2014, a total of 3360 patients who were confirmed as CAS by the acetylcholine (Ach) provocation test and without significant coronary lesion were retrospectively analyzed. AMI was an initial presentation in 34 patients [CAS-myocardial infarction (MI) group], and not in other 3326 patients (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 between the two groups, except the higher smoking rate in CAS-MI group (38.2 vs. 23.5%, P=0.046). During a mean follow-up period of 1211±583 days, the cumulative incidence of recurrent angina [hazard ratio (HR): 2.71; 95% confidence interval (CI): 1.20-6.13; P=0.016], MI (HR: 33.89; 95% CI: 8.76-131.1; P<0.001) and major adverse cardiovascular events (MACE; HR: 10.94; 95% CI: 3.83-31.22; P<0.001) were significantly higher in the CAS-MI group. After propensity score matched analysis (1: 5 matching; n=186, C-statistic=0.834), the incidences of recurrent angina (HR; 4.68; 95% CI: 1.62-13.5; P=0.004) and MACE (HR: 12.2; 95% CI: 2.23-67.3; P=0.003) remained higher in the CAS-MI group. Conclusion The CAS-MI group patients were associated with higher incidence of recurrent angina, MI, and MACE compared to CAS group patients. More intensive antispastic medication might be needed for these patients, and further study will be necessary to determine which treatment can improve the prognosis of CAS-MI patients.

AB - Background The long-term clinical outcomes of coronary artery spasm (CAS) patients presented with acute myocardial infarction (AMI) compared to those who did not present with AMI has rarely been investigated. Methods From November 2004 to May 2014, a total of 3360 patients who were confirmed as CAS by the acetylcholine (Ach) provocation test and without significant coronary lesion were retrospectively analyzed. AMI was an initial presentation in 34 patients [CAS-myocardial infarction (MI) group], and not in other 3326 patients (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 between the two groups, except the higher smoking rate in CAS-MI group (38.2 vs. 23.5%, P=0.046). During a mean follow-up period of 1211±583 days, the cumulative incidence of recurrent angina [hazard ratio (HR): 2.71; 95% confidence interval (CI): 1.20-6.13; P=0.016], MI (HR: 33.89; 95% CI: 8.76-131.1; P<0.001) and major adverse cardiovascular events (MACE; HR: 10.94; 95% CI: 3.83-31.22; P<0.001) were significantly higher in the CAS-MI group. After propensity score matched analysis (1: 5 matching; n=186, C-statistic=0.834), the incidences of recurrent angina (HR; 4.68; 95% CI: 1.62-13.5; P=0.004) and MACE (HR: 12.2; 95% CI: 2.23-67.3; P=0.003) remained higher in the CAS-MI group. Conclusion The CAS-MI group patients were associated with higher incidence of recurrent angina, MI, and MACE compared to CAS group patients. More intensive antispastic medication might be needed for these patients, and further study will be necessary to determine which treatment can improve the prognosis of CAS-MI patients.

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