Coronary microvascular spasm causes myocardial ischemia in patients with vasospastic angina
Key result
Coronary microvascular spasm occurs without epicardial involvement in ~26% of vasospastic angina patients, predominantly women.
- n=55
Why the study?
It was unknown whether coronary microvessel disease contributes to angina in patients with vasospastic angina attributable to epicardial coronary artery spasm.
Does coronary microvascular spasm contribute to myocardial ischemia in patients with vasospastic angina?
Population
55 consecutive patients with angina and intracoronary acetylcholine-provoked epicardial coronary spasm
Comparison
Patients with microvascular spasm vs patients with epicardial spasm only
Authors
Discussion
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Implication
Coronary microvascular spasm contributes to myocardial ischemia in a sizable portion (25.5%) of patients with epicardial vasospasm, particularly in women with prolonged anginal pain.
Key Points
- To determine whether coronary microvascular spasm alone induces myocardial ischemia in patients with vasospastic angina and to assess differences in clinical characteristics between patients with and without microvascular spasm.
- Evaluated N=55 consecutive patients with angina undergoing intracoronary acetylcholine provocation testing for epicardial coronary spasm.
- Assessed ischemic indicators including chest pain, electrocardiogram changes, and myocardial lactate production alongside angiographic visualization during submaximal and maximal acetylcholine provocation.
- In 14 of 55 patients (25.5%, Group 1), submaximal acetylcholine provoked myocardial ischemia without large epicardial spasm, whereas 41 of 55 patients (Group 2) showed ischemia only during angiographically confirmed epicardial spasm.
- Group 1 patients were predominantly female (p < 0.05) with a history of prolonged chest pain exceeding 30 minutes (p < 0.05), whereas Group 2 patients were more frequently male and smokers (p < 0.01).
Study Design
Type
Observational (n=55)
Structured PICO
Does coronary microvascular spasm contribute to myocardial ischemia in patients with vasospastic angina?
P
Population
55 consecutive patients with angina and epicardial coronary spasm provoked by intracoronary acetylcholine.
E
Exposure
Intracoronary acetylcholine (ACH) provocation testing
C
Comparator
Patients with epicardial spasm only (Group 2, n=41)
O
Outcome
Myocardial ischemia (chest pain, ischemic electrocardiogram changes, lactate production) without large epicardial spasmsurrogate
Coronary microvascular spasm contributes to myocardial ischemia in a sizable portion (25.5%) of patients with epicardial vasospasm, particularly in women with prolonged anginal pain.
Cite This Study
Sun et al. (2002) conducted an observational in Vasospastic angina (n=55). Coronary microvascular spasm vs. Epicardial spasm only was evaluated on Myocardial ischemia without large epicardial spasm. Coronary microvascular spasm caused myocardial ischemia without large epicardial spasm in 25.5% of patients with vasospastic angina, occurring predominantly in women.