Structural and Functional Coronary Artery Abnormalities in Patients With Vasospastic Angina Pectoris

Abstract

Coronary spasm is involved in many clinical scenarios, such as stable angina, acute coronary syndrome, sudden cardiac death, non-ischemic cardiomyopathy, arrhythmia and syncope. In recent years, imaging tools such as computerized tomographic angiography, intravascular ultrasound or optical coherence tomography have been applied to study the coronary pathology in patients with vasospastic angina. Patients with vasospastic angina represent a heterogeneous cohort of patients with regard to the extent of concomitant coronary atherosclerosis. They share the common pathophysiological phenomenon of vascular smooth muscle hyperreactivity leading to spasm caused by various factors that may also overlap. Focal coronary spasm is related to epicardial atherosclerosis and in the presence of obstructive coronary artery disease it may be useful to treat the lesion to prevent further spasm. The aim of this article is to review structural and functional coronary artery abnormalities in patients with vasospastic angina. (Circ J 2015; 79: 1431 -1438

The Who, What, Why, When, How and Where of Vasospastic Angina

“…69, 131 Although the etiology of this vascular hyper-reactivity remains elusive, significant advances in the responsible molecular mechanisms have been made with the development of a miniature swine coronary artery vasospastic model. 69, 132 However, further human studies are required to evaluate the clinical relevance of these mechanisms and explore novel therapeutic targets.…”

Impact of Stent Type and Presence of Vasospastic Angina on Long-Term Prognosis

“…7 Among these mechanisms, endothelial dysfunction is a well-established response to cardiovascular risk factors and precedes the development of coronary artery disease. First-generation DES are associated with incomplete stent endothelialization and endothelial dysfunction, whereas BMS is associated with an almost preserved endothelial function.…”

A man with chest pain and a broad QRS complex tachycardia

“…Vasospastic angina can occur in both normal and diseased coronary arteries and was initially described by Myron Prinzmetal in 1959 23. Prinzmetal’s original case series of patients with “variant angina” (vasospastic angina) involved 32 cases of angina not associated with exercise.…”