Coronary artery spasm as a frequent cause of acute coronary syndrome - The CASPAR (coronary artery spasm in patients with acute coronary syndrome) study
Coronary artery spasm as a frequent cause of acute coronary syndrome - The CASPAR (coronary artery spasm in patients with acute coronary syndrome) study
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DOI：
10.1016/j.jacc.2008.04.050
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发表时间：
2008-08-12
影响因子：
24
通讯作者：
Sechtem, Udo
中科院分区：
文献类型：
--
作者：
Ong, Peter;Athanasiadis, Anastasios;Sechtem, Udo
目的了解疑似急性冠脉综合征(ACS)并伴有急性静息胸痛的急诊患者冠脉痉挛的发生率。急性冠脉综合征怀疑心脏标记物升高、缺血性心电改变或仅仅是典型的不稳定(通常是静息)心绞痛的临床症状。然而，在所有接受冠状动脉造影术的疑似急性冠脉综合征患者中，高达30%的患者冠状动脉没有阻塞。方法在2006年6月至12月进行的一项前瞻性研究中，所有疑似急性冠脉综合征患者均接受了冠状动脉造影术，且无致病因素，均接受了乙酰胆碱冠状动脉内激发治疗。当冠脉内注射硝酸甘油后血管收缩<gt；=75%，当最初报告的症状可以再现时，ACH检测被认为是阳性。结果连续488例患者中，138例(28%)没有罪魁祸首病变。22人被发现有另一种诊断。其余116名患者中有86名患者接受了ACH检测。42例确诊为冠状动脉痉挛(49%)。结论每4例急性冠脉综合征患者中就有1例无致命性病变。在ACH检测的患者中，有近50%可以记录到冠状动脉痉挛。冠脉痉挛是急性冠脉综合征的常见原因，应经常考虑作为鉴别诊断。
Objectives This study was conducted to clarify the incidence of coronary spasm in emergency patients with suspected acute coronary syndrome (ACS) and acute chest pain at rest.Background Chest pain at rest is a frequent symptom in the emergency room. Acute coronary syndrome is suspected in patients with elevation of cardiac markers, ischemic electrocardiographic changes, or simply typical clinical symptoms of unstable (usually resting) angina. However, of all patients with suspected ACS who undergo coronary angiography, up to 30% have nonobstructed coronary arteries. We sought to clarify how many of these patients suffer from coronary spasm as a possible cause of their chest pain.Methods In a prospective study from June to December 2006, all patients with suspected ACS who underwent coronary angiography and had no culprit lesion underwent intracoronary provocation with acetylcholine. The ACH testing was considered positive at a vasoconstriction of >= 75% relative to the diameter after intracoronary nitroglycerine when the initially reported symptoms could be reproduced.Results Of 488 consecutive patients, 138 had no culprit lesion (28%). Twenty-two were found to have another diagnosis. The ACH testing was performed in 86 of the remaining 116 patients. In 42 patients, coronary spasm was verified (49%).Conclusions Every fourth patient with ACS had no culprit lesion. Coronary spasm could be documented in nearly 50% of the patients tested by ACH. Coronary spasm is a frequent cause of ACS and should regularly be considered as a differential diagnosis.