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Stress testing in patients with coronary spasm: comparison of those with and without fixed coronary artery disease
R Castelló1, E Alegría, A Merino
1Dpto. de Cardiología y Cirugía Cardiovascular, Clínica Universitaria de Navarra, Pamplona, Spain.
Insights
Stress testing is less reliable for diagnosing coronary artery spasm (CAS). While ST-segment depression during exercise may indicate underlying coronary artery disease (CAD), normal results or ST-segment elevation are common in CAS patients.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Stress testing is a key noninvasive tool for detecting coronary artery disease (CAD).
- The utility of stress testing in patients with coronary artery spasm (CAS) remains unclear.
Purpose of the Study:
- To evaluate the effectiveness of stress testing in identifying coronary artery disease (CAD) in patients with documented coronary artery spasm (CAS).
Main Methods:
- Ninety-one patients with angiographically confirmed CAS underwent symptom-limited bicycle exercise stress tests prior to coronary angiography.
- Analysis focused on ST-segment changes during exercise and correlation with the presence and severity of CAD.
Main Results:
- Half of CAS patients (50.5%) had normal stress test results.
- ST-segment elevation was uncommon (8.8%) and did not reliably differentiate CAD presence.
- ST-segment depression occurred in 40.7% and was strongly associated with underlying fixed CAD (62% of those with depression had CAD).
Conclusions:
- Stress testing has limited value in diagnosing CAD in CAS patients, with many showing normal results.
- ST-segment depression during stress testing is the most significant indicator of underlying coronary artery disease in this population.
- ST-segment elevation is not a reliable marker for CAD in patients with CAS.
Abstract:
Stress testing is one of the preferred noninvasive methods of identifying patients with coronary artery disease (CAD). Its value in patients with coronary artery spasm (CAS) is, however, difficult to ascertain. The authors studied 91 consecutive patients with angiographically documented CAS. All patients underwent a symptom-limited bicycle exercise test before coronary angiography. Eight patients (8.8%) showed ST-segment elevation during exercise; 37 (40.7%), ST-segment depression; and 46 (50.5%), no changes. Thirty patients had normal coronary arteries; 19, one-vessel disease; 19, two-vessel disease; and 23, three-vessel disease. Stress testing yielded abnormal results in 7 of 30 patients (23%) with no CAD and in 38 of 61 (62%) with fixed CAD (p less than 0.01). ST-segment response to exercise did not correlate with most clinical findings such as age, type of angina, duration of pain episodes, or the degree of disease activity. However, a significant correlation was found with the extent and severity of CAD. Absence of ST changes or ST-segment elevation did not differentiate those patients with or without CAD, but only 4 of 37 patients with ST-segment depression had no significant fixed lesions. In conclusion, half of the patients with CAS had a normal stress test. ST-segment elevation is an uncommon finding in these patients and does not reliably differentiate those with and without fixed CAD. The only relevant finding of stress testing in CAS patients is ST-segment depression, which strongly suggests the presence of underlying CAD.