Park Tae Shik, Ahn Woo Jin, Choi Byoung Geol, Choi Se Yeon, Cha Jinah, Hyun Sujin, Sinurat Markz R M P, Park Soohyung, Choi Cheol Ung, Park Chang Gyu, Oh Dong Joo, Rha Seung-Woon
Division of Cardiology, VCU Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia, USA.
National Emergency Medical Center, National Medical Center, Seoul, Korea.
Catheter Cardiovasc Interv. 2025 Jul;106(1):464-471. doi: 10.1002/ccd.31569. Epub 2025 Apr 30.
Coronary artery spasm (CAS) causes vasospastic angina in patients without significant coronary artery stenosis. However, there has been limited investigation regarding the CAS patterns within this population. This study aims to evaluate the incidence and patterns of CAS in patients with non-severe coronary artery stenosis using intracoronary ergonovine (ERG) provocation test.
A total of 884 patients experiencing angina with non-severe coronary artery stenosis who underwent intracoronary ERG provocation test between January 2018 and December 2022 were enrolled. Patients were categorized into two groups, based on the severity of coronary artery stenosis: the Non-group (stenosis < 30%, n = 732), and the Mild-to-moderate group (30%-69%, n = 152). Significant CAS was defined as arterial narrowing of ≥ 70%, and vasomotor responses were observed in each group.
The baseline clinical characteristics of the Mild-to-moderate group were worse than the Non-group. They were older with higher prevalence of hypertension, diabetes mellitus, dyslipidemia, and smokers. During the ERG test, CAS was observed in 37.7% of the overall population. The Mild-to-moderate group (54.6%) showed a higher incidence than the Non-group (34.2%, p < 0.001). The Mild-to-moderate group demonstrated odds ratio of 2.31 for CAS compared to the Non-group (95% CI: 1.60-3.33, p < 0.001) even after adjustment.
A considerable number of patients experiencing angina with non-severe coronary artery stenosis were found to have CAS. Moreover, CAS was observed more frequently in patients with mild to moderate coronary artery stenosis compared to those without any fixed stenosis.
冠状动脉痉挛（CAS）可导致无明显冠状动脉狭窄的患者发生血管痉挛性心绞痛。然而，对于该人群中CAS模式的研究有限。本研究旨在使用冠状动脉内麦角新碱（ERG）激发试验评估非严重冠状动脉狭窄患者中CAS的发生率和模式。
纳入2018年1月至2022年12月期间接受冠状动脉内ERG激发试验的884例非严重冠状动脉狭窄且有心绞痛症状的患者。根据冠状动脉狭窄的严重程度，将患者分为两组：无狭窄组（狭窄<30%，n = 732）和轻至中度狭窄组（30%-69%，n = 152）。将显著CAS定义为动脉狭窄≥70%，并观察每组的血管运动反应。
轻至中度狭窄组的基线临床特征比无狭窄组更差。他们年龄更大，高血压、糖尿病、血脂异常和吸烟者的患病率更高。在ERG试验期间，总体人群中37.7%观察到CAS。轻至中度狭窄组（54.6%）的发生率高于无狭窄组（34.2%，p<0.001）。即使在调整后，轻至中度狭窄组CAS的比值比为2.31，高于无狭窄组（95%CI：1.60-3.33，p<0.001）。
发现相当数量的非严重冠状动脉狭窄且有心绞痛症状的患者存在CAS。此外，与无任何固定狭窄的患者相比，轻至中度冠状动脉狭窄患者中CAS的观察频率更高。
