Key result
Intracoronary acetylcholine provocation testing revealed epicardial coronary spasm as the underlying cause of a non-ST-segment elevation myocardial infarction without a culprit lesion.
Why the study?
Coronary artery spasm is a frequent cause of acute coronary syndrome without culprit lesion, but its role in non-ST-segment elevation myocardial infarction remains to be illustrated.
Case Report (n=1)
No
May identify vasospasm in NSTEMI without culprit; leaves open prospective validation of routine provocation testing.
A 68-year-old white woman was referred to our hospital by her general practitioner, with symptoms of acute coronary ischemia: she reported severe chest pain at rest that had started 12 h earlier accompanied by palpitations. She has been suffering from angina on exertion as well as at rest for several months. Her cardiovascular risk factors were arterial hypertension, hypercholesterolemia (low density lipoprotein (LDL) of 4.1 mmol/l (74 mg/dl) under treatment with simvastatin 30 mg o.d.) and a positive family history for cardiovascular disease (her mother had suffered from angina pectoris and her grandfather had a myocardial infarction at the age of 76 years). In addition, she had been a cigarette smoker until 1999. The initial electrocardiogram (ECG) showed negative T-waves in
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Kilzheimer et al. (2014) conducted a case report in Non-ST-segment elevation myocardial infarction without culprit lesion (n=1). Intracoronary acetylcholine provocation testing was evaluated. Intracoronary acetylcholine provocation testing revealed epicardial coronary spasm as the underlying cause of a non-ST-segment elevation myocardial infarction without a culprit lesion.
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