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Coronary Artery Spasm: New Insights.
Anthony Matta1,2, Frederic Bouisset1, Thibault Lhermusier1
1Department of Cardiology, Institute CARDIOMET, CHU-Toulouse, Toulouse, France.
Journal of Interventional Cardiology
|June 9, 2020
Summary
Coronary artery spasm (CAS) is a common cause of ischemia with no obstructive coronary artery disease (INOCA). Provocative testing remains key for diagnosing CAS, guiding treatment with medications or interventions.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Coronary artery spasm (CAS) is the most frequent diagnosis in patients with ischemia with no obstructive coronary artery disease (INOCA), regardless of demographics.
- Its prevalence appears to be declining due to improved management of atherosclerotic risk factors and reduced use of functional reactivity testing.
Purpose of the Study:
- To review the pathophysiology, diagnosis, and management of coronary artery spasm (CAS).
- To highlight the role of provocative testing in diagnosing CAS and guiding therapy.
Main Methods:
- Review of current literature on coronary artery spasm (CAS).
- Discussion of diagnostic modalities, focusing on provocative testing.
- Overview of therapeutic strategies, including pharmacologic and interventional approaches.
Main Results:
- CAS is a complex condition with multifactorial pathophysiology involving the autonomic nervous system, endothelial dysfunction, inflammation, oxidative stress, and smooth muscle hypercontractility.
- Provocative testing is the cornerstone for diagnosing CAS, enabling reproduction of spasm and assessment of nitrate response.
- Long-acting nondihydropyridine calcium channel blockers are first-line therapy; PCI and CABG are options for CAS with significant atherosclerotic lesions.
Conclusions:
- Despite advances in cardiac imaging, provocative testing remains essential for CAS diagnosis.
- Management strategies range from medical therapy to invasive procedures, with combination therapies for refractory cases.
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