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
Department of Internal Medicine, Division of Cardiology, Sejong General Hospital, Bucheon.
Cardiovascular Center, Korea University Guro Hospital.
Coron Artery Dis. 2018 Jan;29(1):60-67. doi: 10.1097/MCA.0000000000000558.
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.
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.
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.
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.
与未发生急性心肌梗死（AMI）的冠状动脉痉挛（CAS）患者相比，发生AMI的CAS患者的长期临床结局鲜有研究。
回顾性分析2004年11月至2014年5月期间，共3360例经乙酰胆碱（Ach）激发试验确诊为CAS且无显著冠状动脉病变的患者。34例患者首次表现为AMI[CAS-心肌梗死（MI）组]，其他3326例患者未发生AMI（CAS组）。比较两组患者5年的临床结局。
两组患者的基线特征和心血管危险因素无差异，但CAS-MI组吸烟率较高（38.2%对23.5%，P=0.046）。在平均随访1211±583天期间，CAS-MI组复发性心绞痛的累积发生率[风险比（HR）：2.71；95%置信区间（CI）：1.20-6.13；P=0.016]、MI（HR：33.89；95%CI：8.76-131.1；P<0.001）和主要不良心血管事件（MACE；HR：10.94；95%CI：3.83-31.22；P<0.001）显著更高。倾向评分匹配分析（1:5匹配；n=186，C统计量=0.834）后，CAS-MI组复发性心绞痛（HR；4.68；95%CI：1.62-13.5；P=0.004）和MACE（HR：12.2；95%CI：2.23-67.3；P=0.003）的发生率仍然较高。
与CAS组患者相比，CAS-MI组患者复发性心绞痛、MI和MACE的发生率更高。这些患者可能需要更强化的抗痉挛药物治疗，需要进一步研究以确定哪种治疗可改善CAS-MI患者的预后。
