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

Study Questions:

What is the long-term outcome of patients with acute coronary syndrome (ACS) who have no identifiable coronary artery disease on angiography, but have evidence of spasm in response to intracoronary acetylcholine?

Methods:

The authors reported the 3-year results of the CASPAR (Coronary Artery Spasm as a Frequent Cause for Acute Coronary Syndrome) study. In this study, all patients with ACS who had no identifiable coronary artery lesion, underwent intracoronary acetylcholine-induced provocation.

Results:

No coronary lesion was identified in 28% of the patients. Patients without a culprit lesion had an excellent prognosis with no cardiac death or nonfatal myocardial infarction during follow-up. One of the patients died from a noncardiac cause. Persistent angina was reported in 38 of 76 patients, and repeat angiography was performed in three patients (3.9%). Cardiac death occurred in 11.1 % of patients with a culprit lesion, whereas 4.8% died from noncardiac causes. A nonfatal myocardial infarction occurred in 4.1% of the cohort.

Conclusions:

ACS patients without culprit lesion and proof of coronary spasm have an excellent 3-year survival.

Perspective:

Approximately 10% of patients with ACS have no or minimal angiographic disease (Roe MT, et al., Circulation 2000;102:1101-6). Multiple studies have demonstrated good short-term outcome in this group, although long-term data have been conspicuously absent. This study demonstrates that these patients have a very low risk of hard events, although a significant number of patients will continue to have disabling angina pectoris.

Clinical Topics: Acute Coronary Syndromes, Stable Ischemic Heart Disease, Atherosclerotic Disease (CAD/PAD), Chronic Angina

Keywords: Prognosis, Spasm, Coronary Artery Disease, Myocardial Infarction, Coronary Vasospasm, Acute Coronary Syndrome, Follow-Up Studies, Coronary Disease


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