Key result
Provoked coronary spasm linked to ~240% higher MACE risk in MI with obstructive coronary arteries.
Why the study?
Coronary spasm may contribute to the pathogenesis of both MICAD and MINOCA, but data concerning its significance in acute myocardial infarction are limited.
Does a positive provocative spasm test predict major adverse cardiac events in patients with acute myocardial infarction with or without obstructive coronary arteries?
Cohort (n=267)
Does a positive provocative spasm test predict major adverse cardiac events in patients with acute myocardial infarction with or without obstructive coronary arteries?
Effect estimate: HR 3.40 (95% CI 1.20-12.25)
Absolute Event Rate: 18.9% vs 7.3%
p-value: p=0.019
A positive provocative spasm test is associated with a higher risk of major adverse cardiac events in patients with acute myocardial infarction, regardless of the presence of obstructive coronary artery disease.
Spasm positivity may stratify MACE risk in MICAD; leaves open whether testing alters management or outcomes.
BACKGROUND AND AIMS: Coronary spasm may contribute to the pathogenesis of myocardial infarction with obstructive coronary artery disease (MICAD) and warrants close consideration in myocardial infarction with non-obstructive coronary arteries (MINOCA). However, data concerning the significance of coronary spasm in acute myocardial infarction (AMI) are limited. We assessed the prognostic significance of provocative spasm tests among MICAD and MINOCA patients. METHODS AND RESULTS: We retrospectively screened 731 consecutive patients with AMI, of whom 267 (MICAD, n = 198; MINOCA, n = 69) underwent an invasive provocative spasm test. The primary endpoint was major adverse cardiac events (MACE). Provocative spasm testing was positive in 143 (72.2%) of MICAD group and 33 (47.8%) of MINOCA group. During a median follow-up of 48 months, MACE occurred in 31 patients (15.7%) in the MICAD group compared with 4 patients (5.8%) in the MINOCA group (p = 0.037). Spasm-positive patients had a significantly higher incidence of MACE compared with spasm-negative patients in both the MICAD group (27 [18.9%] vs. 4 [7.3%]; p = 0.044) and MINOCA group (4 [12.1%] vs. 0 [0%]; p = 0.047). Kaplan-Meier survival analysis of the 4 groups categorized by type of AMI (MICAD or MINOCA) and presence of provoked coronary spasm showed that spasm-positive status was associated with lower MACE-free survival across both AMI subtypes (log-rank p = 0.011). In multivariable analysis, provoked coronary spasm was independently associated with MACE in the MICAD group (hazard ratio, 3.40; 95% confidence interval, 1.20-12.25; p = 0.019). CONCLUSION: Provocative spasm tests could provide prognostic stratification for AMI patients, irrespective of whether they present with MICAD or MINOCA.
No takes yet. Share an insight, caveat, or question.
Ozawa et al. (2026) conducted a cohort in Acute myocardial infarction (MICAD and MINOCA) (n=267). Provocative spasm test (positive) vs. Provocative spasm test (negative) was evaluated on Major adverse cardiac events (MACE) (HR 3.40, 95% CI 1.20-12.25, p=0.019). Provoked coronary spasm was independently associated with major adverse cardiac events in patients with myocardial infarction with obstructive coronary arteries (HR 3.40; 95% CI 1.20-12.25; p=0.019).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: