Potential Treatments for Refractory Vasospastic Angina

Vasospastic angina (VSA) is a common disease that causes rest/effort angina attacks globally. Coronary spasms occur in patients with and without atherosclerotic coronary stenosis based on the underlying causative mechanisms and triggers. The first-line and effective treatments, which are calcium channel blockers and nitrates, have been established as shown in the multiple guidelines. However, it is also well known that some refractory VSA patients do not respond to standard therapy and remain to complain of angina symptom. Furthermore, severe clinical manifestations such as acute coronary syndrome and lethal arrhythmia may occur, which often disturb daily life. Thus, additional personalized treatments for individual refractory VSA patient are mandatory. Although scientific reports with a high level of evidence regarding treatments for refractory VSA are limited, a significant number of reports have been published including case series reports that showed successful empirical treatments. Each therapy might not be appropriate for all patients but may be effective for patients with specific characteristics owing to the mechanism and trigger of spasm. In this review, the optional pharmacological and invasive treatments for refractory VSA are described.