Coronary Plaque Characteristics and Cut-Off Stenosis for Developing Spasm in Patients with Vasospastic Angina

Abstract

Coronary plaque distribution, frequency and cut-off value of percent stenosis for developing vasospasm are uncertain in patients with vasospastic angina (VA). We enrolled 2960 patients who received coronary angiography (CAG) and ergonovine provocation test prospectively in 11 university hospitals in Korea. A total of 1836 patients with VA and 867 without VA were included. Plaque and % stenosis were defined as ≥1% luminal narrowing and mean of each segmental stenosis. Overall frequency of plaque and % diameter stenosis was compared among VA-patients with index coronary spasm positive, those with index arterial spasm negative/other arterial spasm positive (INOP) and non-VA patients. Diameter stenosis associated with the spasm positivity was investigated. Overall plaque frequency and % stenosis were higher in VA patients than non-VA patients. Plaque frequency was 27.6% (243/881) in spasm positive at LAD, 16.4% (157/955) in LAD INOP and 12.6% (109/867) in non-VA with statistic difference (P < 0.001). Same trend for higher rate was observed in LCx and RCA. For % stenosis, 36.6 vs 32.4% (p = 0.010) in LAD, 36.1 vs. 28% (p < 0.001) in LCx and 35.3 vs.30.0% (p = 0.047) in RCA, respectively. Diameter stenosis of LAD with spasm positive vs. LAD INOP vs. non-VA were 38.3%, 34.0%, 32% (P = 0.002) with similar pattern in LCx and RCA. By multivariate logistic regression analysis, coronary stenosis of LAD ≥ 35% or LCx ≥35% or RCA ≥ 40% were independent predictor of developing spasm (OR 2.019, 95% CI 1.315–3.100, P = 0.001). In conclusions, spastic coronary artery had more plaque frequency, higher % stenosis than in non-spastic coronary in VA patients. The spasm related and unrelated coronary in VA patients had more plaque than in matched and unmatched coronary arteries in non-VA patients. Coronary stenosis ≥35% in LAD and LCx was an independent predictor of developing spasm.

An Unusual ST-Segment Elevation in Unexplained Syncope

“…The lambdalike ST-segment elevation, corresponding to the distribution of the major coronary artery in inferior leads (II, III, and aVF), was related to complete spastic occlusion of the LCX or RCA. Experimental and clinical studies have confirmed that atherosclerotic plaque can induce vasospasm; conversely, spasm itself can initiate or aggravate atherosclerosis . Initially, spasm occurs in the LCX based on severe organic stenosis of the middle segment.…”

“…Experimental and clinical studies have confirmed that atherosclerotic plaque can induce vasospasm; conversely, spasm itself can initiate or aggravate atherosclerosis. 7 Initially, spasm occurs in the LCX based on severe organic stenosis of the middle segment. In this patient, the higher ST-segment elevation in lead II compared with lead III and ST-segment elevation in leads I, aVL, and V 4 through V 6 with ST-segment depression in leads aVR and V 1 through V 3 collectively suggest total occlusion of the LCX (Figure , A).…”