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Relation of coronary arterial spasm to sites of organic stenosis
Insights
Coronary arterial spasm in Prinzmetal's variant angina frequently occurs at sites of existing organic stenosis. This association suggests that underlying coronary artery disease plays a key role in the development of vasospastic angina attacks.
Area of Science:
- Cardiology
- Vascular Biology
- Clinical Medicine
Background:
- Prinzmetal's variant angina is characterized by coronary arterial spasm.
- The relationship between coronary spasm and pre-existing organic stenosis is not fully understood.
Purpose of the Study:
- To investigate the association between coronary arterial spasm and organic stenosis in patients with variant angina.
- To determine the localization of coronary spasm relative to sites of organic coronary artery disease.
Main Methods:
- Arteriographic documentation of coronary arterial spasm in patients with Prinzmetal's variant angina.
- Analysis of coronary angiograms to assess the presence and location of organic stenosis and spasm.
- Review of published literature on coronary spasm and organic coronary artery disease.
Main Results:
- In 9 out of 63 patients, coronary spasm was documented arteriographically.
- Coronary spasm occurred at sites of pre-existing organic stenosis in most observed episodes.
- In a combined analysis of 104 patients, 90% of those with single vessel coronary spasm had spasm involving the diseased vessel.
- Literature review indicated that 88% of cases described spasm localized to the site of organic lesions.
Conclusions:
- Coronary arterial spasm in variant angina is intimately associated with sites of organic stenosis in the majority of cases.
- Pathophysiological hypotheses for variant angina must consider the role of underlying coronary artery disease in triggering or localizing spasm.
Abstract:
Among 63 patients with Prinzmetal's variant angina, coronary arterial spasm responsible for attacks of variant angina was documented arteriographically in 9 patients. In each observed episode (11 attacks in nine patients), coronary spasm producing myocardial ischemia occurred at and was superimposed on a site of preexisting organic stenosis. Measurements of normal portions of "spastic" and "nonspastic" vessels suggested a generalized uniform constriction of all major coronary arteries during attacks, with "spasm" limited to the site of an organic lesion in most cases. In two cases the magnitude of constriction in all vessels was consistent with generalized coronary hypercontractility or spasm. Among 104 patients with organic coronary artery disease and documented single vessel coronary spasm (foregoing 9 patients combined with 95 others from published reports), there were 70 patients with essentially single vessel organic coronary disease in 90 percent of whom the spasm involved the diseased vessel. Of 60 cases abstracted from the literature in which the relation of coronary spasm to the site of organic disease was described, 88 percent had the spasm causing ischemia localized to the site of an organic lesion. Hypotheses attempting to describe the pathophysiologic aspects of coronary spasm in variant angina must account for the intimate association of spasm with sites of organic stenosis in the majority of cases.
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