Key result
Intracoronary nitroglycerin reverses multivessel coronary spasm and restores TIMI 3 flow following inferior STEMI.
Why the study?
Coronary vasospasm is an uncommon, potentially fatal cause of ST-segment elevation myocardial infarction with nonobstructive coronary arteries (MINOCA) that is easily missed when structural heart disease coexists.
Case Report (n=1)
No
Highlights that severe occlusive multivessel coronary vasospasm can cause cardiac arrest and transmural STEMI despite a recent normal angiogram, and can be diagnosed and reversed with intracoronary nitroglycerin after excluding aortic dissection extension.
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Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Consider occlusive vasospasm in ST-segment elevation with previously nonobstructive coronaries; exclude aortic causes, then use intracoronary nitroglycerin diagnostically and therapeutically.”
Clinicians should consider occlusive vasospasm in complex STEMI-MINOCA; this single case leaves open systematic evaluation before changing practice.
Background Coronary vasospasm is an uncommon but potentially fatal cause of ST-segment elevation myocardial infarction with nonobstructive coronary arteries (MINOCA), and is easily missed when structural disease coexists. Case Summary A 63-year-old man with heart failure with reduced ejection fraction, chronic atrial fibrillation, Stanford type B aortic dissection, and nonobstructive coronaries 3 months earlier presented with decompensated heart failure. Peri-Valsalva, he sustained ventricular fibrillation arrest requiring prolonged resuscitation; post-return of spontaneous circulation electrocardiogram showed inferior ST-segment elevation. Aortography excluded retrograde flap extension; angiography revealed right coronary occlusion with left-system spasm, all reversed by intracoronary nitroglycerin (600 μg, TIMI flow grade 3). Cardiac magnetic resonance confirmed transmural inferior infarction; calcium-channel blockade followed. Discussion Coronary vasospasm is an under-recognized, potentially fatal functional cause of MINOCA; registries show vasospastic arrest survivors face high recurrence. A recent nonobstructive angiogram excludes neither spasm nor infarction, and coexisting aortic dissection mandates ascending aortography first. Take-Home Message Consider occlusive vasospasm in ST-segment elevation with previously nonobstructive coronaries; exclude aortic causes, then use intracoronary nitroglycerin diagnostically and therapeutically.
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Nicolela et al. (2026) conducted a case report in ST-segment elevation myocardial infarction with nonobstructive coronary arteries (MINOCA) and cardiac arrest due to occlusive multivessel coronary vasospasm (n=1). Intracoronary nitroglycerin followed by calcium-channel blockade was evaluated on Reversal of coronary occlusion and multivessel spasm. Intracoronary nitroglycerin (600 μg) reversed right coronary occlusion and left-system spasm, restoring TIMI grade 3 flow after VF arrest and inferior STEMI.
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