Cigarette smoking during coronary angiography: Diffuse or focal narrowing (spasm) of the coronary arteries in 13 patients with angina at rest and normal coronary angiograms

Abstract

To evaluate the acute effects of cigarette smoking on coronary arteries (CA), repeated coronary angiograms were performed in 13 patients with angina at rest and with normal coronary angiograms at basal state, during smoking, and then after methylergometrine (MEM) and after intracoronary nitroglycerin. Smoking induced anginal pain in three patients, triggered spasm (focal narrowing) in six, and/or an abnormal segmental diffuse narrowing (greater than 30%) in eight. The narrowing of the left CA was on average -21 +/- 13% (P less than 0.001), with more important narrowing of the mid-left anterior descending (-29 +/- 19%, P less than 0.001). The mean of the maximal segmental narrowing by patient was -34 +/- 13% (P less than 0.001). MEM produced similar effects and induced focal CA spasms in nearly the same patients at the same sites. Cigarette smoking may induce vasoconstrictive effects on CA in patients with rest angina and normal coronary angiograms. This action is not dose-dependent and may be initiated by less than one cigarette. These observations offer a new perspective for the understanding of the role of smoking in the precipitation of coronary events.

Catheter-induced Vasospasm of Both the Right External Iliac and Right Coronary Arteries During Coronary Angiography

“…Proposed mechanisms include mechanical irritation triggering a myogenic reflex [6,7], stress receptor activation [8], and platelet aggregation at the catheter tip with release of vasoactive agents [9]. Several underlying etiologies have been documented including hypercholesterolemia, ergot toxicity, exercise, L-thyroxin therapy, hyperosmolar contrast medium, nonsteroidal anti-inflammatory drugs, cigarette smoking, and alcohol [7,8,[10][11][12][13][14][15][16][17][18]. In accordance with the presence of mild coronary artery disease (CAD) in the LAD and LCx in this patient, she also fits the typical prototype of patients predisposed to coronary vasospasm as previously defined by provocative testing with ergonovine [19].…”

Acute coronary syndrome secondary to allergic coronary vasospasm (Kounis Syndrome): a case series, follow-up and literature review

“…In fact, stress could precipitate allergies and trigger coronary mast cells leading to cardiac events [28]. Though smoking exposure is a recognized risk factor for coronary vasospasm in susceptible individual [29], this patient did not suffer vasospastic angina when he doubled smoking, whereas he did not smoke when the pineapple-induced angina broke out, implying that smoking was not the direct inducer of vasospasm. Thus neither pineapple-induced anaphylaxis nor smoking independently triggered vasospasm events.…”

Novel Aspects of Differences in Arterial Stiffness Parameters during Short Abstinent Period in Smokers vs. Non-smokers

“…Moreover, in the presence of coronary artery disease smoking increases coronary vascular resistance [6] and decreases coronary blood flow [7]. Cigarette smoking during coronary angiography has been observed to acutely trigger coronary vasospasm [8].…”