cardiology careers collections past issues search home
     

J Am Coll Cardiol, 2008; 52:523-527, doi:10.1016/j.jacc.2008.04.050
© 2008 by the American College of Cardiology Foundation
This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow View Related Cardiosource Journal Scan
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Google Scholar
Right arrow Articles by Ong, P.
Right arrow Articles by Sechtem, U.
PubMed
Right arrow Articles by Ong, P.
Right arrow Articles by Sechtem, U.
Related Collections
Right arrowRelated Articles

CLINICAL RESEARCH: CORONARY SPASM

Coronary Artery Spasm as a Frequent Cause of Acute Coronary Syndrome

The CASPAR (Coronary Artery Spasm in Patients With Acute Coronary Syndrome) Study

Peter Ong, MD, Anastasios Athanasiadis, MD, Stephan Hill, MD, Holger Vogelsberg, MD, Matthias Voehringer, MD and Udo Sechtem, MD*

Department of Cardiology and Pulmology, Robert-Bosch-Krankenhaus, Stuttgart, Germany.

Manuscript received November 20, 2007; revised manuscript received April 24, 2008, accepted April 29, 2008.

* Reprint requests and correspondence: Dr. Udo Sechtem, Robert-Bosch-Krankenhaus, Department of Cardiology and Pulmology, Auerbachstrasse 110, 70376 Stuttgart, Germany. (Email: Udo.Sechtem{at}rbk.de).

Objectives: This study was conducted to clarify the incidence of coronary spasm in emergency patients with suspected acute coronary syndrome (ACS) and acute chest pain at rest.

Background: Chest pain at rest is a frequent symptom in the emergency room. Acute coronary syndrome is suspected in patients with elevation of cardiac markers, ischemic electrocardiographic changes, or simply typical clinical symptoms of unstable (usually resting) angina. However, of all patients with suspected ACS who undergo coronary angiography, up to 30% have nonobstructed coronary arteries. We sought to clarify how many of these patients suffer from coronary spasm as a possible cause of their chest pain.

Methods: In a prospective study from June to December 2006, all patients with suspected ACS who underwent coronary angiography and had no culprit lesion underwent intracoronary provocation with acetylcholine. The ACH testing was considered positive at a vasoconstriction of ≥75% relative to the diameter after intracoronary nitroglycerine when the initially reported symptoms could be reproduced.

Results: Of 488 consecutive patients, 138 had no culprit lesion (28%). Twenty-two were found to have another diagnosis. The ACH testing was performed in 86 of the remaining 116 patients. In 42 patients, coronary spasm was verified (49%).

Conclusions: 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.

Key Words: acute coronary syndrome • coronary artery spasm • acetylcholine • culprit lesion • chest pain

Abbreviations and Acronyms
  ACH = acetylcholine
  ACS = acute coronary syndrome
  ECG = electrocardiogram
  LCA = left coronary artery
  NSTEMI = non–ST-segment elevation myocardial infarction
  STEMI = ST-segment elevation myocardial infarction
  UAP = unstable angina pectoris


Related Articles

Provoked Coronary Spasm and Acute Coronary Syndromes
Carl J. Pepine
J. Am. Coll. Cardiol. 2008 52: 528-530. [Full Text] [PDF]

Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 52: A33-A34. [Full Text] [PDF]



This article has been cited by other articles:


Home page
JWatch GeneralHome page
Coronary Artery Spasm as a Cause of Acute Coronary Syndrome
Journal Watch (General), September 30, 2008; 2008(930): 1 - 1.
[Full Text]


Home page
J Am Coll CardiolHome page
C. J. Pepine
Provoked Coronary Spasm and Acute Coronary Syndromes
J. Am. Coll. Cardiol., August 12, 2008; 52(7): 528 - 530.
[Full Text] [PDF]



 
  cardiology careers collections past issues search home