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?


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.


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.


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


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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