Coronary Artery Spasm as a Frequent Cause of Acute Coronary Syndrome

Ong, Peter; Athanasiadis, Anastasios; Hill, Stephan; Vogelsberg, Holger; Voehringer, Matthias; Sechtem, Udo

doi:10.1016/j.jacc.2008.04.050

Cited by 299 publications

(79 citation statements)

References 19 publications

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“…41,42 Non-obstructive coronary artery disease with microvascular dysfunction and abnormal coronary reactivity may also be relatively more important in women with STEMI and affect prognosis negatively. 43 In our study, TIMI-flow post PPCI and myocardial blush grades, as indicators of reperfusion, were comparable between women and men in both age groups. This is in concordance with data from previous studies.…”

Section: Discussionsupporting

confidence: 52%

Is the difference in outcome between men and women treated by primary percutaneous coronary intervention age dependent? Gender difference in STEMI stratified on age

Otten

Maas²,

Ottervanger

et al. 2013

European Heart Journal: Acute Cardiovascular Care

114

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on behalf of the Zwolle myocardial infarction study group Abstract Aim: Poorer outcomes in women with ST-elevation myocardial infarction (STEMI) are often attributed to gender differences in baseline characteristics. However, these may be age dependent. We examined the importance of gender in separate age groups of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI). Methods and results: Data of 6746 consecutive patients with STEMI admitted for PPCI between 1998 and 2008 in our hospital were evaluated. Age was stratified into two groups, <65 years (young group) and ≥65 years (elderly). Endpoints were enzymic infarct size as well as 30-day and 1 year mortality. We studied a total of 4991 (74.0%) men and 1755 (26.0%) women; 40% of women were <65 years and 60% of men were <65 years of age. In the elderly group (≥65 years), women had more frequently diabetes and hypertension while they smoked less frequently than men. Younger women smoked more often than similarly aged men and had more hypertension. At angiography, single-vessel disease and TIMI 3 flow before PPCI was more present in younger women than men, whereas these differences were not found in the older age group. Patient delay before admission was shorter in men at all ages, while women had lower creatine kinase levels. Younger women had a higher mortality after 30 days (HR 2.1, 95% CI 1.3−3.4) and at 1 year (HR 1.7, 95% CI 1.2−2.6), whereas in the older age group women mortality rates were higher at 30 days (HR 1.5, 95% CI 1.1−2.0) but not at 1 year (HR 1.2, 95% CI 0.9−1.5). After multivariate analysis, 1-year mortality remained significantly higher in women at younger age (HR 1.7, 95% CI 1.1−2.5). Patient delay before admission was shorter in men in both age groups. Creatine kinase levels were in both age groups higher in men. Conclusions: Differences in mortality between men and women with STEMI treated with PPCI are age dependent. Although young women have less obstructive coronary artery disease and more often TIMI 3 flow before PCI (suggesting a lower risk), survival was worse compared to similarly aged men. Women had a longer patient delay compared to men, but this was not related to gender-specific mortality.

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Section: Discussionsupporting

confidence: 52%

Is the difference in outcome between men and women treated by primary percutaneous coronary intervention age dependent? Gender difference in STEMI stratified on age

Otten

Maas²,

Ottervanger

et al. 2013

European Heart Journal: Acute Cardiovascular Care

114

View full text Add to dashboard Cite

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“…По мнению ученых, лизис тромботических масс приводит к воз-никновению микроциркуляторной эмболии, сопро-вождающейся периферическим коронароспазмом, который вызывает миокардиальную микроцирку-ляторную дисфункцию. Необходимо отметить, что возникновение ОКСспST на этапе первичного меди-цинского контакта у наблюдаемого нами больного, также может быть объяснено ангиоспазмом, ини-циировавшим тромбоз передней нисходящей арте-рии после тяжелой физической нагрузки [3].…”

Section: Discussionunclassified

“…Основанием для отказа от эндоваскулярной коррекции нередко является как выраженное многососудистое поражение венечных артерий, заставляющее интервенционного карди-олога отдать предпочтение «открытой» коронар-ной хирургии, так и отсутствие гемодинамически значимого (стенозов ≥ 50%) атеросклеротического поражения артериального русла сердца. Последняя причина, выявляемая у 10% пациентов с ОКСспST, часто сопряжена с восстановлением нормальной проходимости венечных артерий, но возникнове-нием явлений замедления антеградного кровотока по коронарному артериальному руслу, дистального коронароспазма и снижения периферической мио-кардиальной перфузии [3].…”

Section: Introductionunclassified

A Case of Successful Use of Percutaneous Temporary Occlusion of the Heart Venous Sinus in Patient With Acute Coronary Syndrome With St Segment Elevation in the Absence of Hemodynamically Significant Atherosclerotic Lesions of the Coronary Arteries

Шахов¹,

Шахов²,

Петрова³

et al. 2017

CSO

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“…It has been documented that coronary artery spasm is an important etiology of ACS in patients without obstructive coronary artery disease 10. ACS patients with coronary spasm and nonobstructive coronary artery disease have a favorable prognosis for survival and coronary events 11, 12.…”

Section: Discussionmentioning

confidence: 99%

Clinical Outcomes of Vasospastic Angina Patients Presenting With Acute Coronary Syndrome

Cho

Park

Gwag

et al. 2016

JAHA

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BackgroundCoronary vasospasm is an important pathogenesis of acute coronary syndrome (ACS). However, the clinical features and prognosis of vasospastic angina (VA) patients presenting with ACS (VAACS) are still unclear. We aimed to evaluate the clinical characteristics and long‐term outcomes of VAACS patients without significant coronary artery stenosis.Methods and ResultsA total of 986 VA patients confirmed by ergonovine provocation test were analyzed. VAACS was defined as VA patients visiting the emergency room with documented electrocardiographic changes, significant arrhythmias, or elevated cardiac biomarkers. VA patients with elevated cardiac biomarkers were further considered to have myocardial infarction (MI; VAMI). During 4.4 years of median follow‐up, we investigated major adverse cardiac events including cardiac death, MI, revascularization, and rehospitalization because of recurrent angina. The VAACS group consisted of 149 patients (15.1%), and VAMI occurred in 81 patients (8.2%). VAACS patients were younger and had a higher prevalence of diabetes mellitus, MI history, and higher levels of inflammatory markers compared with non‐VAACS patients. In multivariable Cox regression analyses, VAACS patients were associated with an increased risk of major adverse cardiac events (hazard ratio, 1.65; 95% CI 1.14–2.37; P=0.007) and recurrent MI hazard ratio, 2.57; 95% CI, 1.35–4.87; P=0.004). In addition, VAMI patients had an increased risk of major adverse cardiac events (hazard ratio, 1.75; 95% CI, 1.11–2.76; P=0.016) and recurrent MI (hazard ratio, 2.43; 95% CI, 1.09–5.40; P=0.03).Conclusion VAACS patients showed worse clinical outcomes, driven mainly by recurrent MI. Therefore, intensive medical treatment might be required in VAACS patients.

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Coronary Artery Spasm as a Frequent Cause of Acute Coronary Syndrome

Abstract: Every fourth patient with ACS had no culprit lesion. Coronary spasm could be documented in nearly 50% of the patients tested by ACH. Coronary spasm is a frequent cause of ACS and should regularly be considered as a differential diagnosis.

Cited by 299 publications

References 19 publications

Is the difference in outcome between men and women treated by primary percutaneous coronary intervention age dependent? Gender difference in STEMI stratified on age

Is the difference in outcome between men and women treated by primary percutaneous coronary intervention age dependent? Gender difference in STEMI stratified on age

A Case of Successful Use of Percutaneous Temporary Occlusion of the Heart Venous Sinus in Patient With Acute Coronary Syndrome With St Segment Elevation in the Absence of Hemodynamically Significant Atherosclerotic Lesions of the Coronary Arteries

Clinical Outcomes of Vasospastic Angina Patients Presenting With Acute Coronary Syndrome

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