November 26, 2017Coronary Artery Disease
Clinical characteristics and outcomes of patients with coronary artery spasm who initially presented with acute myocardial infarction
Key result
Initial presentation with acute myocardial infarction in coronary artery spasm patients was associated with a higher risk of MACE (HR 10.94; 95% CI 3.83-31.22; P<0.001).
Why the study?
Does initial presentation with acute myocardial infarction worsen long-term clinical outcomes in patients with coronary artery spasm?
Population
3360 patients confirmed as having coronary artery spasm by the acetylcholine provocation test and without…
Comparison
Initial presentation with acute myocardial… vs Initial presentation without AMI.
Design
Cohort
Follow-up
mean 1211±583 days
Authors
Discussion
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Implication
CAS-MI patients may warrant closer surveillance; leaves open whether tailored strategies improve outcomes in this subgroup.
Key Points
- This research aims to compare long-term clinical outcomes of coronary artery spasm patients presenting with and without acute myocardial infarction.
- Retrospective analysis of 3360 patients diagnosed with coronary artery spasm from November 2004 to May 2014
- Comparison of clinical outcomes over a mean follow-up of 1211 days between CAS-MI and CAS groups
- Utilized propensity score matching for outcome assessment.
- CAS-MI group showed significantly higher incidence of recurrent angina (HR: 2.71; 95% CI: 1.20-6.13; P=0.016)
- MI incidence was 33.89 times higher in the CAS-MI group (P<0.001)
- Major adverse cardiovascular events were also significantly elevated (HR: 10.94; 95% CI: 3.83-31.22; P<0.001).
Study Design
Type
Cohort (n=3,360)
Structured PICO
Does initial presentation with acute myocardial infarction worsen long-term clinical outcomes in patients with coronary artery spasm?
P
Population
3,360 patients with coronary artery spasm without significant coronary lesions, followed for a mean of 1211 days.
E
Exposure
Initial presentation with acute myocardial infarction (AMI) (CAS-MI group, n=34).
C
Comparator
Initial presentation without AMI (CAS group, n=3326).
O
Outcome
Clinical outcomes up to 5 years, including recurrent angina, myocardial infarction (MI), and major adverse cardiovascular events (MACE).composite
Main Result
Hazard Ratio: 10.94 (95% CI 3.83–31.22)
p-value: p=<0.001
Patients with coronary artery spasm who initially present with an acute myocardial infarction have a significantly higher long-term risk of recurrent angina, MI, and MACE, suggesting a need for more intensive antispastic therapy.
Cite This Study
Kim et al. (2017) conducted a cohort in Coronary artery spasm (n=3,360). Initial presentation with acute myocardial infarction vs. Initial presentation without acute myocardial infarction was evaluated on Major adverse cardiovascular events (MACE) (HR 10.94, 95% CI 3.83-31.22, p=<0.001). Initial presentation with acute myocardial infarction in coronary artery spasm patients was associated with a higher risk of MACE (HR 10.94; 95% CI 3.83-31.22; P<0.001).