What does this research mean for the field?

Coronary artery spasm is present in nearly 50% of patients presenting with acute coronary syndrome who have nonobstructed coronary arteries. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine the incidence of coronary artery spasm in emergency patients presenting with suspected acute coronary syndrome and chest pain at rest who have no identifiable culprit lesions.

August 21, 2026Journal of the American College of CardiologyOpen Access

Coronary Artery Spasm as a Frequent Cause of Acute Coronary Syndrome

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Suspected acute coronary syndrome (ACS) and acute chest pain at rest (n=488). Intervention: Intracoronary provocation with acetylcholine. Primary outcome: Coronary spasm verified by acetylcholine testing (vasoconstriction ≥75% and symptom reproduction).

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Key result

Acetylcholine provocation verifies coronary spasm in 49% of suspected ACS patients without culprit lesions.

n=488

Why the study?

Up to 30% of suspected ACS patients undergoing coronary angiography have nonobstructed coronary arteries, but the incidence of coronary spasm causing their symptoms was unclear.

Population

488 consecutive patients with suspected ACS and acute chest pain at rest undergoing coronary angiography

Design

Prospective observational study

Authors

AAAnastasios AthanasiadisInserm SHStephan HillChildren's Hospital of Philadelphia HVHolger VogelsbergRobert Bosch Hospital

Discussion

Member takes

Implication

Prospective study reveals coronary artery spasm in nearly half of acute coronary syndrome patients without culprit lesions, highlighting its importance as a differential diagnosis.

Key Points

To determine the incidence of coronary artery spasm in emergency patients presenting with suspected acute coronary syndrome and chest pain at rest who have no identifiable culprit lesions.
Prospective study conducted between June and December 2006 evaluating consecutive emergency patients (N=488) with suspected acute coronary syndrome undergoing coronary angiography.
Patients without culprit coronary lesions underwent intracoronary provocation testing with acetylcholine.
Positive provocation was defined as >=75% vasoconstriction relative to diameter after intracoronary nitroglycerine alongside reproduction of original clinical symptoms.
Of 488 consecutive patients, 138 (28%) had no culprit lesion on angiography, with 22 diagnosed with alternative conditions.
Among 86 patients who underwent acetylcholine provocation testing, coronary artery spasm was confirmed in 42 patients (49%).

Study Design

Type

Observational (n=488)

PICO

Population

488 consecutive emergency patients with suspected acute coronary syndrome and acute chest pain at rest, of whom 138 had no culprit lesion.

Exposure / Comparator

Intracoronary provocation with acetylcholine

Primary Outcome

Coronary spasm verified by acetylcholine testing (vasoconstriction ≥75% and symptom reproduction)

Cite This Study

Athanasiadis et al. (2008) conducted an observational in Suspected acute coronary syndrome (ACS) and acute chest pain at rest (n=488). Intracoronary provocation with acetylcholine was evaluated on Coronary spasm verified by acetylcholine testing (vasoconstriction ≥75% and symptom reproduction). Intracoronary provocation with acetylcholine verified coronary spasm in 49% (42 of 86) of tested patients with suspected acute coronary syndrome and no culprit lesion.

synapsesocial.com/papers/6a883aa9f03f443a2877d80b https://doi.org/10.1016/j.jacc.2008.04.050

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Implication

Prospective study reveals coronary artery spasm in nearly half of acute coronary syndrome patients without culprit lesions, highlighting its importance as a differential diagnosis.

Coronary Artery Spasm as a Frequent Cause of Acute Coronary Syndrome

Discussion

Member takes

Implication

Key Points

Study Design

PICO

Cite This Study

Coronary Artery Spasm as a Frequent Cause of Acute Coronary Syndrome

Discussion

Member takes

Implication

Key Points

Study Design

PICO

Cite This Study

Also Consider

Also Consider