Prevalence of Coronary Vasospasm Using Coronary Reactivity Testing in Patients With Spontaneous Coronary Artery Dissection

• Published in: The American journal of cardiology 2019-06, Vol.123 (11), p.1812-1815
• Main Authors: White Solaru, Khendi, Heupler, Frederick, Cho, Leslie, Kim, Esther S.H.
• Format: Article
• Language: English
• Subjects: Angina pectoris; Angiography; Blood pressure; Cardiovascular disease; Case reports; Catheterization; Coronary Angiography; Coronary artery; Coronary Vasospasm - epidemiology; Coronary Vasospasm - etiology; Coronary Vessel Anomalies - complications; Coronary Vessel Anomalies - diagnostic imaging; Coronary vessels; Diabetes; Dissection; Dysplasia; Female; Heart; Humans; Hypertension; Intubation; Medical imaging; Medical instruments; Medical records; Middle Aged; Myocardial infarction; Nitrates; Occlusion; Pain; Patients; Prevalence; Retrospective Studies; Trauma; Vascular Diseases - complications; Vascular Diseases - congenital; Vascular Diseases - diagnostic imaging; Vasoconstriction
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2019.03.001

Spontaneous coronary artery dissection (SCAD) is an important cause of myocardial infarction and sudden cardiac death, particularly in young to middle-aged women. Coronary vasospasm is another condition believed to be associated with SCAD; however, this has only been shown in isolated case reports to date. We sought to examine the association of SCAD and coronary vasospasm by reporting the experience of coronary vasospasm testing in patients with a history of previous SCAD in a large, tertiary referral center. We conducted a single-center retrospective review of patients with history of SCAD confirmed by angiography who received provocative testing using ergonovine in the Cleveland Clinic cardiac catheterization lab from January 1990 to December 2016. Positive vasospasm was defined as: (1) total or subtotal occlusion of at least 1 major coronary artery induced by administration of ergonovine and (2) resolution of said occlusion with the administration of nitrates. Patients with history of strong trauma to the chest and iatrogenic dissection (e.g., catheter-induced) were excluded from the study. We identified 11 patients who satisfied all inclusion criteria. All participants were women and the mean age was 47 years: 73% received screening for fibromuscular dysplasia and of those, 38% were found to have the diagnosis. Only 1 of 11 patients had a positive vasospasm test in the setting of ergonovine administration in the catheterization lab. In conclusion, we found a low prevalence of coronary vasospasm in individuals with confirmed previous SCAD.