Coronary Artery Spasm as a Cause of Acute Coronary Syndrome

Coronary artery spasm is a potential cause of ischemia, but what is the incidence of spasm in patients who present to emergency departments with suspected acute coronary syndrome (ACS)? In this European study, investigators studied 488 consecutive patients with suspected ACS (defined as acute chest pain associated with ischemic changes on electrocardiogram or cardiac biomarker elevations) who underwent angiography.

In 138 patients (28%), epicardial coronary angiography did not reveal clear culprit lesions: 22 patients received alternative diagnoses (e.g., myocarditis) without spasm testing; 30 did not undergo spasm testing for various reasons; and 86 underwent provocative testing with intracoronary acetylcholine to see whether spasm (defined…