Effect of coronary artery spasm on long-term outcomes in survivors of acute myocardial infarction
| Autor: | Kazuto Nakamura, Jun-ei Obata, Takamitsu Nakamura, Juntaro Deyama, Daisuke Fujioka, Yukio Saito, Kazuhiro Watanabe, Kiyotaka Kugiyama |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Acute coronary syndrome Time Factors Vasodilator Agents Provocation test Myocardial Infarction Coronary Vasospasm 030204 cardiovascular system & hematology Sudden cardiac death Electrocardiography 03 medical and health sciences 0302 clinical medicine Internal medicine Myocardial Revascularization medicine Clinical endpoint Humans Prospective Studies Survivors 030212 general & internal medicine Myocardial infarction Aged Proportional hazards model business.industry Incidence (epidemiology) Middle Aged medicine.disease Coronary Vessels Acetylcholine humanities Treatment Outcome medicine.anatomical_structure Cardiology Female Cardiology and Cardiovascular Medicine business human activities Follow-Up Studies Artery |
| Zdroj: | International Journal of Cardiology. 257:7-11 |
| ISSN: | 0167-5273 |
| Popis: | Background 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. Methods 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). Results 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 Conclusions 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. Clinical trial registration URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000021340, unique identifier: UMIN000018432. |
| Databáze: | OpenAIRE |
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