Long-term study of recurrent vasospastic angina using coronary angiograms during ergonovine provocation tests

Takatsu, Fumimaro; Osugi, Junichi; Sugiishi, Munetaka; Watarai, Masato; Anno, Takafumi; Toyama, Junji

doi:10.1016/0002-8703(92)91022-s

Cited by 19 publications

(6 citation statements)

References 23 publications

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“…Spasm may reoccur at sites distinct from the stent [75] and continued treatment with calcium channel blockers has been recommended. However in the majority of patients with positive provocation testing and recurrent symptoms, the spastic segment is consistent [76]. The risks of coronary intervention for coronary spasm appear similar to that for other indications [72].…”

Section: Percutaneous Interventionmentioning

confidence: 73%

Is there a role for provocation testing to diagnose coronary artery spasm?

Adlam

Azeem

Turab

et al. 2005

International Journal of Cardiology

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Section: Percutaneous Interventionmentioning

confidence: 73%

Is there a role for provocation testing to diagnose coronary artery spasm?

Adlam

Azeem

Turab

et al. 2005

International Journal of Cardiology

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“…Although several studies have reported the spontaneous remission of vasospastic angina (14-17), persistence of symptoms of variant angina has been reported in other studies with long-term follow-up of up to 10 years (17)(18)(19)(20). Although Kaski et al (21) recently reported the consistency of angiographic location of vasospasm in 10 patients with variant angina despite medical therapy, conflicting and indirect evidence from previous ECG studies (14,22,23) suggests that the location and degree of coronary spasm may not be fixed.…”

Section: Discussionmentioning

confidence: 98%

“…Although Kaski et al (21) recently reported the consistency of angiographic location of vasospasm in 10 patients with variant angina despite medical therapy, conflicting and indirect evidence from previous ECG studies (14,22,23) suggests that the location and degree of coronary spasm may not be fixed. In a nonquantitative coronary angiographic study (18), we previously showed that percent diameter stenosis as assessed visually may fluctuate over time, although the relation of such relative measures to atherosclerosis was not explored. Waters et al (14) reported that the location of myocardial ischemia indicated by ST segment changes at follow-up was similar to that at the initial ergonovine test.…”

Section: Discussionmentioning

confidence: 99%

Fluctuation of spastic location in patients with vasospastic angina: A quantitative angiographic study

1997

ACC Current Journal Review

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Objectives. This study sought to determine whether the location of coronary spastic activity may change over time in patients with persistent variant angina.Background. Although electrocardiographic studies have provided indirect evidence to indicate that the location of ischemia may change in patients with variant angina, it has not been tested by quantitative angiography whether the location of vasospastic activity may change over time.Methods. Paired ergonovine provocation tests and coronary angiography were performed at a mean (-+SD) interval of 43 +-13 months apart in patients with persistent symptoms of vasospastic angina in the absence of significant atherosclerosis. A total of 87 spastic and nonspastic segments of 87 major vessels in 29 patients were analyzed by quantitative angiography at baseline, after the administration of ergonovine and after isosorbide dinitrate at the initial and follow-up tests.Results. Although many clinical studies (4,6,8,9,15,21) have shown that coronary spasm frequently occurs at sites of advanced atherosclerosis, Conti et al. (7) suggested that the presence of significant atherosclerosis may reduce the role of vasospasm in ischemic attacks. To determine the long-term role of vasospastic activity and its variation in location, we repeated ergonovine provocation tests in patients without advanced atherosclerosis but with persistent symptoms of variant angina at an average interval of 43 months apart, using a computer-based quantitative coronary angiographic analysis system (CAAS II). MethodsCriteria of vasospastic angina. The following criteria of vasospastic angina were used: 1) chest pain at rest associated with ST segment changes >0.2 mV on the ECG; 2) pain relief immediately after administration of nitroglycerin; 3) no subsequent evidence of myocardial infarction; 4) ergonovineprovoked coronary spasm associated with chest pain and ischemic ECG changes. Coronary spasm was defined as 1) a transient total or nearly total occlusion reversible with isosorbide dinitrate, or 2) a transient, significant (>50%) narrowing reversible with isosorbide dinitrate in normal or nearly normal segments (24-26). We used the ergonovine provocation test because it has been found (27-29) to have a high sensitivity and ,©1995 hy lhc American (',~llt g¢ ~,! ( ur&,+,~ 0735-1097/95/$9.50 0735-1097(95)00398-N

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“…Previous rare reports have suggested the potential effective role of coronary angioplasty and stenting for the treatment of medically uncontrolled coronary vasospasm. In addition, Ozaki et al [6] have shown that during long-term study of recurrent vasospastic angina the majority of patients seemed to have consistency in the location of coronary spasm, but in some patients (16%) fluctuation of coronary spasm in location and severity was observed. However, Gaspardone et al [5] have shown that three out of nine patients still experienced anginal attacks after stent placement for treatment of coronary vasospasm, and in one patient asymptomatic in-stent restenosis developed.…”

Section: Discussionmentioning

confidence: 99%

Stenting and Surgery for Coronary Vasospasm

Nedeljković

Ostojić

Lalić³

et al. 2009

Herz

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A 55-year-old man, with a history of medically uncontrolled coronary vasospasm, presented for evaluation of chest pain 6 months after implantation of left internal mammary artery. Due to recurrent episodes of vasospastic angina and serious complications of coronary spasm (ventricular fibrillation, myocardial infarction), a stent had previously been implanted in the proximal part of left anterior descending artery at the site of angiographically and ergonovine-proven coronary spasm, with subsequent in-stent restenosis.

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Long-term study of recurrent vasospastic angina using coronary angiograms during ergonovine provocation tests

Cited by 19 publications

References 23 publications

Is there a role for provocation testing to diagnose coronary artery spasm?

Is there a role for provocation testing to diagnose coronary artery spasm?

Fluctuation of spastic location in patients with vasospastic angina: A quantitative angiographic study

Stenting and Surgery for Coronary Vasospasm

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