Rapid Progression of Coronary Atherosclerosis by Coronary Artery Spasm Leading to Acute Coronary Syndrome

Abstract

HomeCirculationVol. 119, No. 16Rapid Progression of Coronary Atherosclerosis by Coronary Artery Spasm Leading to Acute Coronary Syndrome Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessReview ArticlePDF/EPUBRapid Progression of Coronary Atherosclerosis by Coronary Artery Spasm Leading to Acute Coronary Syndrome Ichiro Sakamoto, Masahiro Mohri and Hideo Yamamoto Ichiro SakamotoIchiro Sakamoto From the Department of Cardiology, Kyushu Kosei-Nenkin Hospital, Kitakyushu, Japan. Search for more papers by this author , Masahiro MohriMasahiro Mohri From the Department of Cardiology, Kyushu Kosei-Nenkin Hospital, Kitakyushu, Japan. Search for more papers by this author and Hideo YamamotoHideo Yamamoto From the Department of Cardiology, Kyushu Kosei-Nenkin Hospital, Kitakyushu, Japan. Search for more papers by this author Originally published28 Apr 2009https://doi.org/10.1161/CIRCULATIONAHA.108.839522Circulation. 2009;119:2233–2234A 67-year-old normotensive, normolipidemic man presented with short-lasting chest pain followed by syncope. Intracoronary ergonovine maleate (40 μg) provoked a severe spasm in the middle portion of right coronary artery (Figure 1A and 1B, arrow), but there was no significant (>50%) right or left coronary artery disease after intracoronary nitrates (Figure 1C). The patient was diagnosed as having vasospastic angina. Download figureDownload PowerPointFigure 1. Right coronary arteriograms before (A) and after intracoronary ergonovine (B) and isosorbide dinitrate (ISDN; C).Three years later, he presented with sustained, nitroglycerin-resistant chest pain at our emergency room. Emergent coronary arteriography revealed a high-grade stenosis where coronary spasm had been documented earlier (Figure 2A, arrow). Intracoronary administration of isosorbide dinitrate improved distal filling but failed to dilate the stenosed segment (Figure 2B). Intravascular ultrasound confirmed coronary plaque at that segment (Figure 2B, inset), and a bare metal stent was successfully implanted (Figure 2C). Serial changes in serum enzymes confirmed the diagnosis of acute non–ST-elevation myocardial infarction. Download figureDownload PowerPointFigure 2. Right coronary arteriograms before (A) and after intracoronary isosorbide dinitrate (ISDN; B) and percutaneous coronary intervention (PCI; C).Although coronary spasm has been implicated to cause atherosclerosis progression over years,1 there are few reports demonstrating a critical role of coronary artery spasm in rapid plaque progression and the development of acute coronary syndrome. Because there was no disease progression in left coronary artery segments, it was assumed that focal spasm might have contributed to a ruptured atheromatous plaque in our patient, leading eventually to myocardial infarction. Previous experimental studies have shown that coronary artery spasm could cause intraplaque hemorrhage and acute myocardial infarction in the swine model.2 Thus, coronary vasospasm may play an important role in the pathogenesis of not only variant angina but also acute coronary syndrome, as seen in this patient.DisclosuresNone.FootnotesCorrespondence to Masahiro Mohri, MD, PhD, Department of Cardiology, Kyushu Kosei-Nenkin Hospital, 1-8-1 Kishinoura, Kitakyushu 806-8501, Japan. E-mail [email protected]References1 Nobuyoshi M, Tanaka M, Nosaka H, Kimura T, Yokoi H, Hamasaki N, Kim K, Shindo T, Kimura K. Progression of coronary atherosclerosis: is coronary spasm related to progression? J Am Coll Cardiol. 1991; 18: 904–910.CrossrefMedlineGoogle Scholar2 Kuga T, Tagawa H, Tomoike H, Mitsuoka W, Egashira S, Ohara Y, Takeshita A, Nakamura M. Role of coronary artery spasm in progression of organic coronary stenosis and acute myocardial infarction in a swine model: importance of mode of onset and duration of coronary artery spasm. Circulation. 1993; 87: 573–582.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Kim J, Park J, Yang Y, Lee S, Kim D, Song J, Kang D, Park S, Park S and Song J (2022) Percutaneous coronary intervention in patients with documented coronary vasospasm during long-term follow-up, Heart, 10.1136/heartjnl-2021-320645, 108:16, (1303-1309), Online publication date: 1-Aug-2022. Mori H, Takahashi J, Sato K, Miyata S, Takagi Y, Tsunoda R, Sumiyoshi T, Matsui M, Tanabe Y, Sueda S, Momomura S, Kaikita K, Yasuda S, Ogawa H, Shimokawa H and Suzuki H (2020) The impact of antiplatelet therapy on patients with vasospastic angina: A multicenter registry study of the Japanese Coronary Spasm Association, IJC Heart & Vasculature, 10.1016/j.ijcha.2020.100561, 29, (100561), Online publication date: 1-Aug-2020. Montenegro Sá F, Ruivo C, Graça Santos L, Antunes A, Soares F, Baptista J and Morais J (2018) Ultra-rapid progression of coronary artery disease or undiagnosed unstable plaque? A brief review from a case report, Revista Portuguesa de Cardiologia (English Edition), 10.1016/j.repce.2018.02.016, 37:3, (259-264), Online publication date: 1-Mar-2018. Montenegro Sá F, Ruivo C, Graça Santos L, Antunes A, Campos Soares F, Baptista J and Morais J (2018) Progressão ultrarrápida de doença coronária ou placa instável não detetada?, Revista Portuguesa de Cardiologia, 10.1016/j.repc.2017.04.005, 37:3, (259-264), Online publication date: 1-Mar-2018. Shah P, Bajaj S, Virk H, Bikkina M and Shamoon F (2015) Rapid Progression of Coronary Atherosclerosis: A Review, Thrombosis, 10.1155/2015/634983, 2015, (1-6), Online publication date: 28-Dec-2016. April 28, 2009Vol 119, Issue 16 Advertisement Article InformationMetrics https://doi.org/10.1161/CIRCULATIONAHA.108.839522PMID: 19398679 Originally publishedApril 28, 2009 PDF download Advertisement SubjectsAcute Coronary Syndromes