Suivi à 5 ans des patients porteurs d'un spasme coronaire documenté par un test de provocation à l'acétylcholine coronaire

Background: Long-term clinical outcome data according to severity of coronary artery spasm (CAS) as assessed by an intracoronary acetylcholine provocation test are limited in series of Asian patients. Aim: To investigate 5-year clinical outcomes in patients with CAS according to CAS severity. Methods: In total, 5873 consecutive patients with insignificant coronary artery disease (< 70% fixed stenosis) who underwent an acetylcholine provocation test were enrolled and divided into four groups according to CAS severity during the acetylcholine provocation test: negative, borderline positive, moderately positive and severely positive. CAS severity was assessed by quantitative coronary angiography. We investigated 5-year clinical outcomes according to CAS severity. Results: Over a follow-up period of up to 5 years, before adjustment, the severely-positive CAS group showed a significantly higher incidence of major adverse cardiac events (MACE; composite of death, myocardial infarction and de novo revascularization) (hazard ratio [HR]: 1.834, 95% confidence interval [CI]: 1.047–3.211; P = 0.033), total death (HR: 3.124, 95% CI: 1.047–9.322; P = 0.041), myocardial infarction (HR: 3.190, 95% CI: 1.069–9.519; P = 0.037) and recurrent angina (HR: 1.762, 95% CI: 1.363–2.278; P < 0.001) compared with the negative group. However, after adjustment for baseline confounders, only the incidence of recurrent angina (HR: 1.323, 95% CI: 1.014–1.726; P = 0.039) was significantly higher in the severely-positive CAS group compared with the negative group. Conclusions: The severity of CAS in the positive group was not associated with an increased incidence of MACE after adjustment for covariates compared with the negative group, but the severely-positive CAS group was associated with a higher incidence of recurrent angina compared with the negative group.