3-Year Follow-Up of Patients With Coronary Artery Spasm as Cause of Acute Coronary Syndrome The CASPAR (Coronary Artery Spasm in Patients With Acute Coronary Syndrome) Study Follow-Up
3-Year Follow-Up of Patients With Coronary Artery Spasm as Cause of Acute Coronary Syndrome The CASPAR (Coronary Artery Spasm in Patients With Acute Coronary Syndrome) Study Follow-Up
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DOI：
10.1016/j.jacc.2010.08.626
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发表时间：
2011-01-11
影响因子：
24
通讯作者：
Sechtem, Udo
中科院分区：
文献类型：
--
作者：
Ong, Peter;Athanasiadis, Anastasios;Sechtem, Udo
目的：我们试图确定无罪犯病变和冠状动脉痉挛证据的急性冠状动脉综合征患者的预后，在3年的following.Background冠状动脉痉挛已被确定为急性冠状动脉综合征（ACS）的一个替代原因，在无罪犯病变的患者。在CASPAR（冠状动脉痉挛是急性冠状动脉综合征的常见原因）研究中，我们最近发现，在冠状动脉内乙酰胆碱激发治疗的无罪犯病变的ACS患者中，约有50%发生冠状动脉痉挛。然而，在这些patients.Methods的预后数据稀疏3年的随访后，获得以下终点的数据：死亡（心脏和非心脏），非致命性心肌梗死，心绞痛复发导致重复冠状动脉造影。结果无罪犯病变的患者随访期间无心源性死亡或非致死性心肌梗死，1例非心源性死亡。然而，76例患者中有38例报告了持续性心绞痛，其中3例（3.9%）需要重复血管造影。270例罪犯病变患者中有30例死于心脏原因（11.1%），13例死于非心脏原因（4.8%）。11例患者发生非致命性心肌梗死（4.1%），27例患者因持续或复发性心绞痛而重复血管造影（10%）。结论无罪犯病变和冠状动脉痉挛证据的ACS患者3年后的生存率和冠状动脉事件发生率均高于梗阻性ACS患者（P < 0.0005）。然而，持续性心绞痛在这些患者中是一个具有挑战性的问题，在某些情况下导致重复冠状动脉造影。（J Am科尔心脏病学杂志2011;57：147-52）（C）美国心脏病学会基金会2011年
Objectives We sought to determine the prognosis of patients with acute coronary syndrome without culprit lesion and proof of coronary spasm during 3 years of follow-up.Background Coronary artery spasm has been identified as an alternative cause for acute coronary syndrome (ACS) in patients without culprit lesion. In the CASPAR (Coronary Artery Spasm as a Frequent Cause for Acute Coronary Syndrome) study, we recently showed that similar to 50% of ACS patients without culprit lesion, in whom intracoronary acetylcholine provocation was performed, had coronary spasm. However, data on prognosis in these patients are sparse.Methods After 3 years of follow-up, data regarding the following end points were obtained: death (cardiac and noncardiac), nonfatal myocardial infarction, and recurrent angina leading to repeated coronary angiography. The analysis focused on patients with a culprit lesion (n = 270) and patients without a culprit lesion (n = 76) but with acetylcholine provocation (total n = 346).Results In patients without culprit lesion, there was no cardiac death or nonfatal myocardial infarction during follow-up; 1 patient died due to a noncardiac cause. However, 38 of 76 patients reported persistent angina requiring repeated angiography in 3 cases (3.9%). Thirty of 270 patients with culprit lesion died due to a cardiac cause (11.1%) and 13 due to a noncardiac cause (4.8%). Eleven patients had nonfatal myocardial infarction (4.1%) and 27 repeated angiography due to persistent or recurrent angina (10%). Patients with a culprit lesion had a higher mortality and more coronary events compared with those without (p < 0.0005, log-rank test).Conclusions ACS patients without culprit lesion and proof of coronary spasm have an excellent prognosis for survival and coronary events after 3 years compared with patients with obstructive ACS. However, persistent angina represents a challenging problem in these patients, leading in some cases to repeated coronary angiography. (J Am Coll Cardiol 2011;57:147-52) (C) 2011 by the American College of Cardiology Foundation