Coronary Spasms in Heart Attack Point to Poor Outcomes
Patients with provoked spasms have more adverse events; spasms common in acute coronary syndrome
THURSDAY, Aug. 7 (HealthDay News) -- Provoked coronary spasms in patients with acute myocardial infarction are associated with adverse outcomes, and coronary spasms are frequently the cause of acute coronary syndrome, according to two studies published in the Aug. 12 issue of the Journal of the American College of Cardiology.
In the first study, Kohei Wakabayashi, M.D., Ph.D., of the Showa University Fujigaoka Hospital in Yokohama, Japan, and colleagues analyzed data from 240 Japanese patients with acute myocardial infarction who underwent spasm provocation tests with acetylcholine. Coronary spasms occurred in 174 of the patients. During a mean 43 months of follow-up, major adverse cardiac events -- including death and acute coronary syndrome -- were significantly more likely in the group positive for spasms; these events occurred in 47.1 percent of the positive group and 27.3 percent of the negative group.
In the other study, Peter Ong, M.D., of the Robert-Bosch-Krankenhaus in Stuttgart, Germany, and colleagues analyzed data from 488 patients with suspected acute coronary syndrome, 138 of whom were not found to have a culprit lesion. Eighty-six of these patients underwent acetylcholine testing, and 49 percent demonstrated coronary spasm. Coronary spasm is a frequent cause of acute coronary syndrome, and should often be considered as a differential diagnosis, the authors write.
"Why does the frequency of coronary artery spasm seem to be decreasing? Modification of atherosclerosis risk factors, in particular cigarette smoking, which has been strongly associated with coronary artery spasm, and statin and calcium antagonist use account for some reduction. But with the increase in diabetes, hypertension, obesity, drug-eluting stent use, and methamphetamines or cocaine use, it would be unlikely that the incidence of spasm is truly declining. It is more likely that the decline in testing accounts for the perception that spasm has declined," writes the author of an accompanying editorial.