Gender aspects in patients with angina and unobstructed coronary arteries

Ong, Peter; Athanasiadis, Anastasios; Sechtem, Udo

doi:10.1007/s11789-013-0058-x

Cited by 7 publications

(2 citation statements)

References 63 publications

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“…Patients with epicardial CAS tend to be more often male, with a great burden of traditional cardiovascular risk factors—in particular a smoking habit, along with a higher prevalence of diffuse non-obstructive coronary atherosclerosis—are more likely to present with MINOCA [ 84 , 91 , 92 ]. Conversely, patients with microvascular CAS tend to be more often female and to have a longer history of angina [ 33 , 34 , 35 ].…”

Section: Invasive Provocative Testingmentioning

confidence: 99%

Coronary Spasm Testing with Acetylcholine: A Powerful Tool for a Personalized Therapy of Coronary Vasomotor Disorders

Gurgoglione,

Vignali,

Montone

et al. 2024

Life

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Coronary vasomotor disorders (CVD) are characterized by transient hypercontraction of coronary vascular smooth muscle cells, leading to hypercontraction of epicardial and/or microvascular coronary circulation. CVDs play a relevant role in the pathogenesis of ischemia, angina and myocardial infarction with non-obstructive coronary arteries. Invasive provocative testing with intracoronary Acetylcholine (ACh) administration is the gold standard tool for addressing CVD, providing relevant therapeutic and prognostic implications. However, safety concerns preclude the widespread incorporation of the ACh test into clinical practice. The purpose of this review is to shed light on the pathophysiology underlying CVD and on the clinical role of the ACh test, focusing on safety profile and prognostic implications. We will also discuss contemporary evidence on the management of CVD and the role of the ACh test in driving a personalized approach of patients with CVD.

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Section: Invasive Provocative Testingmentioning

confidence: 99%

Coronary Spasm Testing with Acetylcholine: A Powerful Tool for a Personalized Therapy of Coronary Vasomotor Disorders

Gurgoglione,

Vignali,

Montone

et al. 2024

Life

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“…However, over time other concepts of the pathogenesis of angina pectoris were also considered [1]. In patients without stenosing epicardial coronary artery disease (CAD), functional coronary abnormalities, such as coronary spasm, impaired microvascular vasodilatation or enhanced microvascular resistance represent plausible causes of angina [2]. The 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes as well as an EAPCI Expert Consensus Document on Ischemia with Non-Obstructive Coronary Arteries [3] detail the systematic evaluation of patients with ischemia with non-obstructive coronary artery disease (INOCA) [4].…”

Section: Introductionmentioning

confidence: 99%

Epicardial atherosclerosis and coronary tortuosity in patients with acetylcholine-induced coronary spasm

McChord¹,

Gollwitzer²,

Seitz³

et al. 2022

Coronary Artery Disease

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Background Angina pectoris in the absence of relevant epicardial stenoses is frequently caused by coronary spasm. This mechanism of angina is common yet underdiagnosed in daily clinical practice. The pathophysiology of coronary spasm is complex, multifactorial, and not completely understood. The purpose of this study was to analyze the relationship between macroscopic coronary morphologies and coronary spasm. Methods Epicardial atherosclerosis, coronary vessel tortuosity, coronary aneurysms, and myocardial bridges were analyzed angiographically in 610 patients and a potential association with the result of an intracoronary acetylcholine (ACh) provocation test was investigated. Results The comparison showed that angiographic morphologic variations in the coronary arteries are related to the occurrence of coronary spasm. We observed a strong association between the presence of epicardial atherosclerosis and epicardial spasm [87 patients of 179 with epicardial spasm had epicardial atherosclerosis (49%) vs. 45 patients of 172 with microvascular spasm (26%) vs. 89 patients of 259 with negative/inconclusive ACh test (36%); P < 0.005]. Moreover, we found a higher frequency of coronary tortuosity in patients with microvascular spasm [99 patients of 172 with microvascular spasm had at least moderate coronary tortuosity (58%) vs. 76 patients of 179 with epicardial spasm (43%) vs. 126 patients of 259 with negative/inconclusive ACh test (49%); P = 0.017]. Multivariable analysis revealed epicardial atherosclerosis (<50% stenosis) on coronary angiography as a predictor for epicardial spasm (OR, 2.096; 95% CI, 1.467–2.995; P < 0.0005). Female sex (OR, 5.469; 95% CI, 3.433–8.713; P < 0.0005), and exertional angina (OR, 2.411; 95% CI, 1.597–3.639; P < 0.0005) were predictors of microvascular spasm in multivariable analysis. Conclusion In angina patients with no obstructive coronary artery disease, epicardial atherosclerosis is associated with ACh-induced epicardial coronary spasm. Moreover, coronary microvascular spasm is more prevalent in female patients and those with exertional angina. Our results provide insights into the relationship between coronary morphology and coronary vasomotor function.

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Gender differences in therapeutic recommendation after diagnostic coronary angiography: insights from the Coronary Angiography and PCI Registry of the German Society of Cardiology

et al. 2015

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In pts with significant CAD, there was no difference in recommendation for PCI between the genders in stable CAD, whereas in STEMI and NSTE-ACS women were treated even more often with PCI. There were only minor differences in referral for CABG between women and men. Hence, our data provide strong evidence against a gender bias in use of invasive therapeutic procedures once the diagnosis of significant CAD has been confirmed.

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Gender aspects in patients with angina and unobstructed coronary arteries

Cited by 7 publications

References 63 publications

Coronary Spasm Testing with Acetylcholine: A Powerful Tool for a Personalized Therapy of Coronary Vasomotor Disorders

Coronary Spasm Testing with Acetylcholine: A Powerful Tool for a Personalized Therapy of Coronary Vasomotor Disorders

Epicardial atherosclerosis and coronary tortuosity in patients with acetylcholine-induced coronary spasm

Gender differences in therapeutic recommendation after diagnostic coronary angiography: insights from the Coronary Angiography and PCI Registry of the German Society of Cardiology

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