Coronary microvascular spasm causes myocardial ischemia in patients with vasospastic angina

Hongtao Sun, Masahiro Mohri, Hiroaki Shimokawa, Makoto Usui, Lemmy Urakami, Akira Takeshita

Research output: Contribution to journalArticle

107 Citations (Scopus)

Abstract

OBJECTIVES: We aimed to test the hypothesis that coronary microvascular spasm (MVS) alone causes myocardial ischemia in patients with angina attributable to epicardial coronary spasm, and to determine whether there is a difference in clinical characteristics between those with and without microvascular spasm. BACKGROUND: Patients with "vasospastic angina" have epicardial coronary artery spasm, but it is unknown whether coronary microvessel disease also contributes to the occurrence of angina in these patients. METHODS: We studied 55 consecutive patients with angina in whom epicardial coronary spasm was provoked by intracoronary acetylcholine (ACH). RESULTS: In 14 patients (25.5%, Group 1), submaximal dose of ACH induced myocardial ischemia (chest pain, ischemic electrocardiogram changes, lactate production) without large epicardial spasm, suggesting the occurrence of coronary microvascular spasm. By contrast, the remaining 41 patients (Group 2) had evidence of myocardial ischemia only when epicardial spasm was angiographically demonstrated. The Group 1 patients were predominantly women (p < 0.05) and had a history of prolonged (>30 min) chest pain (p < 0.05), whereas the Group 2 patients were more likely men and smokers (p < 0.01). CONCLUSIONS: Myocardial ischemia most probably due to coronary MVS was demonstrated in a sizable portion of patients with epicardial vasospasm, preferentially in women having both typical and prolonged anginal pain. The result suggests that coronary microvascular disease may also contribute to angina in patients with "vasospastic angina."

Original languageEnglish
Pages (from-to)847-851
Number of pages5
JournalJournal of the American College of Cardiology
Volume39
Issue number5
DOIs
Publication statusPublished - 2002 Mar 6
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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