Peeters Denise, Woelders Eva, Jansen Tijn, Konst Regina, Crooijmans Caïa, van de Hoef Tim, Mensink Frans, Los Jonathan, Pellegrini Dario, Cornel Jan Hein, Ong Peter, van Royen Niels, Leen Aukelien, Elias-Smale Suzette, van Geuns Robert Jan, Damman Peter
Radboudumc, Cardiology, Nijmegen, the Netherlands.
UMC Utrecht, Cardiology, Utrecht, the Netherlands.
JACC Cardiovasc Imaging. 2025 Feb;18(2):226-239. doi: 10.1016/j.jcmg.2024.05.024. Epub 2024 Aug 7.
In at least one-half of the patients with angina or ischemia and nonobstructive coronary arteries undergoing coronary function testing, coronary artery spasm (CAS) is detected. CAS is associated with an adverse prognosis regarding recurrent complaints and ischemic events. Current treatment options are mainly focused on the complaints, not on the underlying pathophysiological process. In this review we discuss available evidence regarding the presence, amount, and morphology of atherosclerosis in CAS patients. The reviewed evidence confirmed that atherosclerosis and vulnerable plaque characteristics are often detected in patients with CAS. The amount of atherosclerosis is higher in patients with focal CAS compared with patients with diffuse CAS. Severity of atherosclerosis is associated with the presence of CAS and the prognosis in CAS patients with atherosclerotic stenosis is worse. Therefore, CAS patients with atherosclerosis might benefit from targeted atherosclerotic treatment. Longitudinal studies are needed to elucidate the exact relation between atherosclerosis and CAS.
在至少一半接受冠状动脉功能测试的心绞痛或缺血且冠状动脉无阻塞的患者中，检测到冠状动脉痉挛（CAS）。CAS与复发性症状和缺血事件的不良预后相关。目前的治疗选择主要集中在症状上，而非潜在的病理生理过程。在本综述中，我们讨论了有关CAS患者动脉粥样硬化的存在、程度和形态的现有证据。综述的证据证实，CAS患者中常检测到动脉粥样硬化和易损斑块特征。与弥漫性CAS患者相比，局灶性CAS患者的动脉粥样硬化程度更高。动脉粥样硬化的严重程度与CAS的存在相关，且有动脉粥样硬化狭窄的CAS患者预后更差。因此，患有动脉粥样硬化的CAS患者可能从针对性的动脉粥样硬化治疗中获益。需要进行纵向研究以阐明动脉粥样硬化与CAS的确切关系。
