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Myocardial infarction in patients with coronary artery spasm demonstrated by angiography
Insights
Myocardial infarction (MI) is frequent in patients with coronary artery spasm (CAS), often occurring in vessels with minimal fixed narrowing. This suggests CAS plays a significant role in MI development.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Coronary artery spasm (CAS) is a known cause of angina pectoris.
- The relationship between CAS and myocardial infarction (MI) requires further elucidation.
- Angiographic evidence of CAS is crucial for diagnosis.
Purpose of the Study:
- To investigate the incidence and characteristics of MI in patients with angiographically demonstrated CAS.
- To determine the correlation between the location of MI and the site of CAS.
- To assess the degree of fixed coronary artery narrowing in vessels supplying infarcted regions.
Main Methods:
- Retrospective analysis of 39 patients with angiographically confirmed CAS.
- Documentation of MI cases and their correlation with CAS.
- Assessment of fixed coronary artery narrowing (CAN) in affected vessels.
- Clinical follow-up for patient outcomes.
Main Results:
- Twelve cases of MI were identified in 11 patients (28% incidence).
- MI location corresponded to ECG changes and the vascular territory of CAS.
- Half of the MI cases occurred in vessels with minimal or no fixed narrowing (5/12).
- Follow-up revealed persistent chest pain, asymptomatic status, or sudden cardiac death.
Conclusions:
- Myocardial infarction is a frequent complication of coronary artery spasm.
- MI in CAS patients can occur independently of significant fixed coronary artery narrowing.
- Coronary artery spasm is a critical factor in the pathogenesis of MI, even without severe stenosis.
Abstract:
Twelve cases of myocardial infarction (MI) were documented in 11 of 39 patients who had coronary artery spasm (CAS) that was observed by angiography either before MI (3 patients), after MI (5 patients), or both before and after MI (3 patients). MI corresponded in location to sites of ECG changes of myocardial ischemia during spontaneous angina pectoris in 7 of 7 patients and to the region of myocardium supplied by the vessel in which CAS was observed by angiography in each patient. MI occurred in the distribution of the right coronary artery in 8 patients and of the left coronary artery in 4 patients. Of 12 vessels that supplied infarcted regions of myocardium, 7 vessels had greater than or equal to 50% diameter fixed coronary artery narrowing (CAN), but the remaining 5 vessels had minimal (10%) or no fixed CAN. In those patients who were studied after MI, coronary angiography demonstrated that only 3 of 9 vessels in the distribution of infarcted regions of myocardium were completely occluded. Clinical follow-up for an average of 1.3 years after MI showed that 7 patients continued to have chest pain, 2 patients were asymptomatic, and 2 patients died suddenly 9 weeks and 1 year, respectively, after MI. Therefore, among our patients with CAS demonstrated by angiography, MIs (1) were frequent (28%), (2) occurred in the distribution of observed coronary spasm, (3) were frequently (5 of 12 arteries) in the distribution of vessels having minimal or no fixed narrowing, and (4) were often (6 of 9 arteries) in the distribution of vessels that were demonstrated to be patient after MI.