Increased Coronary Vasomotor Tone in Acute Myocardial Infarction Patients With Spontaneous Coronary Recanalization

Abstract

To clarify the role of coronary spasm or dynamic coronary obstruction in the development of acute myocardial infarction (AMI) with spontaneous recanalization (SR), symptoms in 296 patients with AMI admitted within 24 h after the onset of chest pain were analyzed just before and after onset, and coronary angiograms were analyzed soon after onset. Patients were divided into 3 groups according to the initial angiographic findings in the infarct-related coronary artery (IRCA): group 1 comprised 172 patients with total occlusion (TIMI O); group 2 comprised 57 patients with subtotal occlusion (TIMI 1,2); and group 3 comprised 67 patients with SR (TIMI 3). The incidence of SR was 20.3% at 0-4 h after onset, 22.2% at 4-6 h, 19.7% at 6-12 h, 24.0% at 12-24 h, and 36.0% at 24 h or later. The incidence of SR did not increase significantly as time elapsed. The incidence of angina at rest and variable-threshold angina before the onset of infarction was only 16.2% in group 1, but was significantly higher in groups 2 (64.3%) and 3 (61.9%). The incidence of intermittent chest pain at onset in group 1 (8.4%) was significantly lower than in groups 2 (54.5%) and 3 (38.8%). Vasodilation of the proximal normal segment adjacent to the stenotic site of the IRCA induced by intracoronary nitroglycerin was significantly higher in groups 2 (11.7 +/- 1.2%) and 3 (20.7 +/- 2.6%) than in group 1 (4.0 +/- 0.6%). These results suggest that coronary spasm or dynamic obstruction may be involved in the pathogenesis of thrombus formation or coronary obstruction causing AMI in many Japanese patients.

Efficacy of Calcium Channel Blocker in the Secondary Prevention of Myocardial Infarction-Retrospective Analysis of the 10-Year Prognosis of Coronary Thrombolysis-Treated Patients-

“…Compared with Western patients, there is more involvement of coronary vasospasm in the development of MI in Japanese patients, [8][9][10] and therefore the potential of CCBs to suppress coronary vasospasm 19 may prevent both myocardial ischemia and the development of cardiac events in Japanese post-MI patients. The reason why NR was particularly effective in suppressing cardiac events in cases under 55 years of age was thought to be as follows.…”

Myocardial infarction with normal coronary arteries: a conundrum with multiple aetiologies and variable prognosis: an update

“…Thus, endothelial dysfunction of angiographically normal coronary arteries can predispose to vasospasm and subsequent thrombosis, resulting in an AMI. Indeed, one study found increased coronary vasomotor tone in AMI patients with spontaneous coronary recanalization [46].…”

<b>Pure Ventricular Septal Myocardial Infarction in a Young Man With Coronary Artery Ectasia</b>

“…4) Atherosclerosis is involved in the pathogenesis of coronary artery ectasia, and reports have indicated that it is an unusual manifestation of atherosclerosis including dysplasia of the tunica media. [5][6][7] On the other hand, it has been also reported to be associated with syphilis, 8) congenital heart disease, 9) polyarteritis nodosa, 10) scleroderma, 11) Ehlers-Danlos syndrome, 12) bacterial infections, 13) familial hypercholesterolemia, 14) and hypertension.…”

“…3,4) Here, we report our experience of a rare case of pure septal infarction that may have been caused by coronary vasospasm provoked in the first septal branch of the ectatic left anterior descending artery in a 30-year-old man.…”