Why the study?
While coronary artery spasm is common in patients with ANOCA and can be diagnosed with acetylcholine provocation testing, there is little evidence on effective treatments for patients with persistent symptoms despite maximally tolerated medical therapy. Transcutaneous electrical nerve stimulation (TENS) is a potential treatment modality requiring evaluation.
Does transcutaneous electrical nerve stimulation (TENS) improve symptom burden and quality of life (SAQ score) in patients with persistent angina due to proven epicardial or microvascular coronary artery spasm despite maximally tolerated medical therapy?
Does transcutaneous electrical nerve stimulation (TENS) improve symptom burden and quality of life (SAQ score) in patients with persistent angina due to proven epicardial or microvascular coronary artery spasm despite maximally tolerated medical therapy?
In this small single-arm pilot study, 1 month of TENS therapy significantly improved angina symptoms and quality of life in patients with refractory coronary artery spasm, warranting evaluation in larger randomized trials.
Background The number of patients with angina pectoris and no obstructive coronary arteries (ANOCA) is estimated to be approximately 40% of all patients undergoing a coronary angiogram due to angina pectoris. The endotype epicardial or microvascular coronary artery vasospasm is present in approximately 60% of patients who have ANOCA. An invasive coronary function test (CFT) is required to diagnose ANOCA and to confirm the presence of coronary artery vasospasm an Acetylcholine provocation test needs to be performed. Whilst clinicians can diagnose coronary artery spasm, there is little evidence on effective treatment modalities. One possible treatment modality is transcutaneous electrical nerve stimulation (TENS). Objective The aim of this pilot study was to assess whether TENS could be a potentially effective treatment modality for patients with proven epicardial or microvascular coronary artery spasm and persistent symptoms despite maximally tolerated medical therapy. Methods 20 patients with proven epicardial or microvascular coronary artery spasm (using Acetylcholine provocation testing) were included in this pilot study performed at a tertiary hospital. All patients received a TENS device with application for the duration of 1 month. Symptom burden and quality of life were assessed using the Seattle Angina questionnaire (SAQ) prior to TENS therapy and compared after one month of TENS therapy. Results The SAQ SS significantly improved from 30 ± 14,4 to 49,1 ± 20,5 (p < 0,0001) in patients with proven coronary artery spasm (epicardial or microvascular) after 1 month of TENS treatment. Four out of five individual components of the SAQ also significantly improved. Conclusion This pilot study has shown that TENS therapy could be a potentially effective treatment modality for patients with epicardial or microvascular coronary artery spasm who remain symptomatic despite maximally tolerated medical therapy. Due to the explorative nature of this study, larger randomized controlled trials are required to confirm these findings.Results
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Vervaat et al. (2026) studied this question.
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