Coronary artery spasm has been proposed as a contributor to ischemic events in acute myocardial infarction (AMI), including both obstructive coronary artery disease and myocardial infarction with non-obstructive coronary arteries (MINOCA). However, its prognostic significance in these settings remains uncertain. A retrospective analysis published in the International Journal of Cardiology evaluated whether invasive provocative spasm testing provides prognostic information in patients with AMI.

Among 731 consecutive patients with AMI, 267 underwent invasive provocative spasm testing. The study population included 198 patients with myocardial infarction with obstructive coronary artery disease (MICAD) and 69 patients with MINOCA. The primary endpoint was major adverse cardiac events (MACE) during follow-up.

Provocative spasm testing was positive in 72.2% of MICAD patients and 47.8% of MINOCA patients. Over a median follow-up period of 48 months, MACE occurred in 31 patients (15.7%) in the MICAD group compared with 4 patients (5.8%) in the MINOCA group (p = 0.037). Kaplan–Meier analysis showed that spasm-positive status was associated with lower MACE-free survival across both AMI subtypes (log-rank p = 0.011). In MICAD, MACE occurred in 18.9% of spasm-positive patients versus 7.3% of spasm-negative patients (p = 0.044). In MINOCA, events occurred in 12.1% of spasm-positive patients compared with none in the spasm-negative group (p = 0.047). Multivariable analysis showed that provoked coronary spasm was independently associated with MACE in the MICAD group (hazard ratio 3.40; 95% CI 1.20–12.25; p = 0.019).

Provoked coronary spasm was associated with lower MACE-free survival among patients with AMI. These findings suggest that provocative spasm testing may help identify higher-risk patients across different AMI subtypes.