Key result
Intracoronary injection of nitroglycerin and anti-spasm medication led to complete resolution of symptoms and no ischemic events over 27 months in a patient with simultaneous two-vessel coronary spasm.
Why the study?
Coronary artery spasm is difficult to diagnose directly due to its transience, and simultaneous total occlusion of two main coronary arteries is rare.
Does intracoronary nitroglycerin and anti-spasm medication resolve symptoms and prevent ischemic events in a patient with simultaneous total occlusion of two main coronary arteries due to spasm?
Case Report (n=1)
Does intracoronary nitroglycerin and anti-spasm medication resolve symptoms and prevent ischemic events in a patient with simultaneous total occlusion of two main coronary arteries due to spasm?
This case highlights the importance of identifying coronary artery spasm in patients presenting with acute myocardial infarction to avoid unnecessary interventional stent therapy.
Multivessel CAS may cause simultaneous total occlusions mimicking ACS; this case extends the spectrum but leaves open prospective validation.
RATIONALE: Coronary artery spasm (CAS) defined by severe reversible focal or diffuse vasoconstriction, plays an essential role in the pathophysiology of acute coronary syndrome but is not very common in the clinic. Due to its transience, it is difficult to diagnose CAS directly, many patients are diagnosed by clinical experience. Here, we report the diagnosis and treatment of a rare case of simultaneous total occlusion due to spasm of the two main coronary arteries by coronary angiography (CAG). PATIENT CONCERNS: A 47-year-old man with no medical history was admitted to our emergency room complaining of sudden-onset chest pain lasting 3 hours. Emergency CAG showed total occlusion of the proximal left anterior descending artery and right coronary artery. DIAGNOSES: Acute myocardial infarction caused by CAS was diagnosed, according to CAG findings and test results. INTERVENTIONS: Intracoronary injection of nitroglycerin and anti-spasm medication. OUTCOMES: The patient was discharged on the 8th day with complete resolution of symptoms and normalization of the electrocardiography findings. No ischemic events occurred during a follow-up for 27 months. LESSONS: This case highlights the significance of identifying CAS in patients with acute myocardial infarction and avoiding blind interventional stent therapy, which requires closer attention from clinicians.
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Wang et al. (2023) conducted a case report in Acute myocardial infarction caused by coronary artery spasm (n=1). Intracoronary injection of nitroglycerin and anti-spasm medication was evaluated on Resolution of symptoms and ischemic events during follow-up. Intracoronary injection of nitroglycerin and anti-spasm medication led to complete resolution of symptoms and no ischemic events over 27 months in a patient with simultaneous two-vessel coronary spasm.
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