Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
Int J Cardiol. 2018 Apr 15;257:7-11. doi: 10.1016/j.ijcard.2017.08.002.
The prevalence of coronary artery spasm (CAS) inducible by intracoronary injection of acetylcholine (ACh) is high in survivors of acute myocardial infarction (AMI). Although there is a potential risk of sudden cardiac death in patients with CAS, the prognostic value of CAS was not clear. Thus, this study examined the effect of CAS on long-term prognosis in survivors of AMI in a prospective manner.
The study included a total of 437 patients with AMI who underwent a CAS provocation test using ACh. All patients were followed prospectively for 5years or until the occurrence of the primary composite endpoint that consisted of cardiac death and acute coronary syndrome (ACS).
CAS was induced in 195 (45%) of the study patients. During the follow-up period, 30 patients had a recurrent event (4 had cardiac death and 26 had ACS). Kaplan-Meier estimates in time-to-first-event analysis demonstrated a similar probability of the primary endpoint in patients with and without inducible CAS (p=0.13, log-rank test). The rate of each component of the composite endpoint was also comparable between the 2 patient groups. In Cox proportional hazards risk analysis, treatment with calcium channel blockers (CCBs) negatively predicted the primary endpoints in patients with inducible CAS (HR, 0.21; 95% CI, 0.08-0.55, p<0.01).
The presence of inducible CAS did not increase the incidence of the cardiac events in AMI survivors. Treatment with CCBs may improve outcomes in AMI survivors with inducible CAS.
URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000021340, unique identifier: UMIN000018432.
在急性心肌梗死（AMI）幸存者中，由冠状动脉内注射乙酰胆碱（ACh）诱导的冠状动脉痉挛（CAS）的发生率很高。虽然 CAS 患者有突发心源性死亡的潜在风险，但 CAS 的预后价值尚不清楚。因此，本研究前瞻性地研究了 CAS 对 AMI 幸存者长期预后的影响。
本研究共纳入 437 例接受 ACh 诱导 CAS 激发试验的 AMI 患者。所有患者均进行前瞻性随访 5 年或直至发生主要复合终点，主要复合终点由心源性死亡和急性冠状动脉综合征（ACS）组成。
研究中有 195 例（45%）患者诱导出 CAS。在随访期间，30 例患者发生了复发性事件（4 例心源性死亡，26 例 ACS）。时间至首次事件分析的 Kaplan-Meier 估计显示，有和无可诱导 CAS 的患者发生主要终点的概率相似（p=0.13，对数秩检验）。两组患者复合终点的各组成部分发生率也相似。在 Cox 比例风险风险分析中，可诱导 CAS 患者中钙通道阻滞剂（CCB）的治疗可负性预测主要终点（HR，0.21；95%CI，0.08-0.55，p<0.01）。
可诱导 CAS 的存在并未增加 AMI 幸存者心脏事件的发生率。CCB 的治疗可能改善可诱导 CAS 的 AMI 幸存者的预后。
网址：https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000021340，唯一识别码：UMIN000018432。
