Guidelines for Diagnosis and Treatment of Patients With Vasospastic Angina (Coronary Spastic Angina) (JCS 2013)

,

doi:10.1253/circj.cj-66-0098

Cited by 397 publications

(329 citation statements)

References 258 publications

Supporting

Mentioning

291

Contrasting

Unclassified

Order By: Relevance

“…Treatment with calcium antagonists and/or nitrates leads to a good prognosis for CAS 13. However, patients with CAS with aborted sudden cardiac arrest have been linked to a poor prognosis compared with those without such a condition 8, 21.…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…The diagnosis of CAS was based on spontaneous angina attacks or a total or subtotal coronary artery narrowing (>90%) during the CAG, accompanied by ischemic electrocardiographic changes and/or chest pain, either spontaneously or in response to a provocative stimulus (eg, acetylcholine, ergonovine, or hyperventilation) 13. The spasm provocation test was performed according to the method included in the Guidelines for Diagnosis and Treatment of Patients with Vasospastic Angina of the Japanese Circulation Society 13. Briefly, after confirming the absence of significant stenotic lesions in both right and left coronary arteries, incremental doses of acetylcholine or ergonovine were injected into the left coronary artery (acetylcholine, 20, 50, and 100 μg; ergonovine, 20, 40, and 60 μg) and the right coronary artery (acetylcholine, 20 and 50 μg; ergonovine, 20, 40, and 60 μg) until coronary vasospasm was detected angiographically or until the maximum dose was administered.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Kamakura

Wada

Ishibashi

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundPreviously described patients with early repolarization syndrome (ERS) may have experienced silent coronary artery spasm (CAS) because the diagnosis of CAS was mainly based on symptoms or coronary angiography findings, without performing a spasm provocation test. This study investigated the significance of CAS diagnosis and evaluated the incidence of silent CAS in patients with possible ERS (ie, idiopathic ventricular fibrillation [VF] and inferolateral J wave).Methods and ResultsThe study included 34 patients with idiopathic VF and inferolateral J wave. Thirteen patients (38%) were diagnosed as having CAS on the basis of coronary angiography with spasm provocation test (n=8) and documentation of spontaneous ST elevation (n=5). Of the 13 patients with CAS, 5 (38%) did not experience chest symptoms before and during VF, and were diagnosed as having silent CAS. The remaining 21 patients (62%), with a negative provocation test result and absence of chest symptoms, were considered to have ERS. During the 92 months of follow‐up, patients with CAS receiving appropriate medical treatment with antianginal drugs showed a favorable outcome. In contrast, 4 of 21 patients with ERS (19%) had VF recurrences. The use of monotherapy or combination therapy, consisting of quinidine, cilostazol, and bepridil, in the 4 patients with ERS, was effective in suppressing VF.ConclusionsApproximately 40% of patients with CAS with documented VF and inferolateral J wave did not experience chest symptoms at the first VF, and could have been misdiagnosed as having ERS. The use of the spasm provocation test is considered essential to differentiate patients for optimal medical treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Kamakura

Wada

Ishibashi

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…We retrospectively analyzed an observational registry of patients with VA based on the Guidelines for Diagnosis and Treatment of Patients with VA 5. An intracoronary ergonovine provocation test was performed according to the clinician's decision in patients who had suspicious symptoms and underwent coronary angiography.…”

Section: Methodsmentioning

confidence: 99%

Clinical Outcomes of Vasospastic Angina Patients Presenting With Acute Coronary Syndrome

Cho

Park

Gwag

et al. 2016

JAHA

View full text Add to dashboard Cite

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.

show abstract

“…However, the coronary spasm per se may cause potentially life-threatening complications including lethal arrhythmias or sudden cardiac death [2,3]. To date, invasive coronary angiography (CAG) with spasm provocation ergonovine (EG) testing is the diagnostic standard, broadly defined in recent VSA management guidelines [4]. However, severe adverse events can be caused by this invasive diagnostic procedure [5].…”

Section: Introductionmentioning

confidence: 99%

Assessing Vessel Tone during Coronary Artery Spasm by Dual-Acquisition Multidetector Computed Tomography Angiography

Jin

Kim²,

Kang

et al. 2017

Cardiology

View full text Add to dashboard Cite

Background: Diminished vascular tone is an established biomarker of heart damage. Little is known about the extent of coronary vessel tone (CVT) with spasm as assessed by dual-acquisition multidetector computed tomography angiography (MCTA) in patients with vasospastic angina (VSA). Objective: We evaluated the CVT modulated by intravenous nitrate injection (INI) using MCTA imaging in VSA patients. Methods: Twenty-one VSA patients (60 ± 9 years; 76% males) who underwent initial MCTA (without morning vasodilation), followed by an intracoronary ergonovine provocation test were included. Within 3 days after the initial MCTA patients received INI followed by 28-vessel segment spasm analyzed by MCTA 3D software, applying the following formula as the definition of CVT index (CVTI): (CSA_{IV nitrate} - CSA_initial/CSA_{IV nitrate}) ×100 %, where CSA is the cross-sectional area. Results: Compared to the initial MCTA measures, the INI provocation resulted in the significant increase of average diameter and CSA at the spasm site (2.60 mm [2.11-3.16] vs. 1.42 mm [1.13-2.13]; 5.37 mm² [3.67-7.54] vs. 1.62 mm² [1.02-3.02]; p < 0.001). The CVTI at the spastic segments was higher than at the proximal reference segments (41.0% [21.8-52.3] vs. 18.8% [5.9-26.6] for CVTI diameter; 65.1% [38.6-77.0] vs. 33.9% [5.2-48.1] for CVTI CSA, respectively). To predict VSA, the cut-off value for CVTI diameter was 38.6% (AUC 0.777; 95% CI 0.653-0.901) and 62.5% (AUC 0.779; 95% CI 0.657-0.902) for CVTI CSA in a receiver-operating characteristic curve analysis, with 57.1% sensitivity and 92.9% specificity. Conclusions: This novel imaging technique for assessing CVT by dual-acquisition MCTA after applying INI provocation is suitable for the detection of coronary artery spasm in patients with VSA.

show abstract

Guidelines for Diagnosis and Treatment of Patients With Vasospastic Angina (Coronary Spastic Angina) (JCS 2013)

Cited by 397 publications

References 258 publications

Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Significance of Coronary Artery Spasm Diagnosis in Patients With Early Repolarization Syndrome

Clinical Outcomes of Vasospastic Angina Patients Presenting With Acute Coronary Syndrome

Assessing Vessel Tone during Coronary Artery Spasm by Dual-Acquisition Multidetector Computed Tomography Angiography

Contact Info

Product

Resources

About