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Multivessel coronary spasm in patients with variant angina: a study with intracoronary injection of acetylcholine
Insights
Multivessel coronary spasm, affecting both left and right coronary arteries, is common in variant angina patients. Acetylcholine provocation revealed this condition in most patients studied.
Area of Science:
- Cardiology
- Clinical Medicine
- Diagnostic Imaging
Background:
- Multivessel coronary spasm incidence in variant angina remains unclear.
- Variant angina is characterized by reversible myocardial ischemia.
Purpose of the Study:
- To determine the incidence of multivessel coronary spasm in patients with variant angina.
- To investigate the efficacy of acetylcholine provocation in inducing coronary spasm.
Main Methods:
- Coronary angiography with selective intracoronary acetylcholine injection in 33 variant angina patients.
- Electrocardiography, 201Tl myocardial scintigraphy, and echocardiography used to predict spasm location.
- Ergonovine maleate used as an alternative provocation agent in one case.
Main Results:
- Acetylcholine induced spasm in at least one coronary artery in 32 of 33 patients.
- Multivessel coronary spasm occurred in 24 patients (73%).
- Nineteen of 25 patients with documented multivessel spasm had normal or near-normal coronary arteries post-nitroglycerin.
Conclusions:
- Multivessel coronary spasm is a frequent finding in patients with variant angina.
- Acetylcholine provocation is effective in diagnosing coronary artery spasm.
- Coronary artery spasm can occur in patients with angiographically normal coronary arteries.
Abstract:
Multivessel coronary spasm has been described but its incidence in patients with variant angina still remains unclear. Thirty-three patients with variant angina were studied during coronary angiographic examination with selective intracoronary injection of acetylcholine (ACh). In all but three patients, the location of ischemia during attack was determined by the electrocardiographic findings, by exercise 201Tl myocardial scintigraphy, and by two-dimensional echocardiography during a hyperventilation test, and the coronary artery (or arteries) responsible for the attack was predicted before the study. ACh induced spasm of at least one coronary artery in all but one patient. ACh induced spasm of both the left and right coronary arteries (i.e., multivessel coronary spasm) in 24 patients: in two of the four patients who were predicted to have spasm of the left coronary artery, in six of the 11 predicted to have spasm of the right coronary artery, in 13 of the 15 predicted to have spasm of both the left and right coronary arteries, and in three of the three in whom coronary artery responsible for attack had not been predicted. This ACh-induced spasm of the left and right coronary arteries occurred separately and no patients showed hemodynamic instability during attack. In one patient in whom multivessel coronary spasm had been predicted and ACh failed to induice coronary spasm, ergonovine maleate (0.2 mg) induced spasm of both the left and right coronary arteries simultaneously, resulting in severe prolonged hypotension. Nineteen of the 25 patients in whom multivessel coronary spasm was documented showed angiographically normal or nearly normal coronary arteries after administration of nitroglycerin.(ABSTRACT TRUNCATED AT 250 WORDS)