Abstract 4218: Usefulness of 64-Row Multi-Detector Computed Tomography for the Evaluation of Patients with Variant Angina

Abstract

Invasive coronary angiography is useful in patients with suspected variant angina to document an episode of coronary artery spasm with provocative test. Previous studies have demonstrated that atherosclerosis is present at the sites of vasospasm. The aim of this study was to clarify the relation between 64-row Multi-detector Computed Tomography (MDCT) findings of coronary artery and vasospasm. A total of 58 patients with suspected variant angina (32 females and 26 males, aged 49 to 87 years, mean 65 ± 9 years) who have no evidence of luminal narrowing in major coronary artery with MDCT and underwent ergonovine test to detect the presence of coronary artery spasm were enrolled in this study. Two patients were excluded because of poor images of MDCT. The criteria of positive ergonovine test was total occlusion or localized occlusive spasm associated with chest pain and ST segment elevation after administration of ergonovine into the left coronary artery. The existence of plaques and calcifications in major coronary artery were evaluated with MDCT. 23 of 56 (41.1%) patients were positive with ergonovine test. 9 of 23 (39.1%) were total occlusion and 14 of 23 (60.9%) were localized spasm. Using MDCT, atherosclerotic lesions were observed at all coronary spasm sites. Among the 33 patients with negative ergonovine test, 7 (21.2%) had no plaques in the coronary artery. Presence of plaques was significant factor for positive ergonovine provocation test (p = 0.03). Patients with positive ergonovine test had coronary artery plaques at the site of coronary spasm sites. Absence of coronary artery plaques with MDCT could rule out variant angina. Correlation between ergonovine provocation test and MDCT findings