Coronary spasm is a frequent cause of ACS and should be taken into account in emergency department patients with chest pain at rest, according to researchers.

Coronary spasm is a frequent cause of acute coronary syndrome (ACS) and should be taken into account in emergency department patients with chest pain at rest, according to researchers based in Stuttgart, Germany.

In the August 12th issue of the Journal of the American College of Cardiology, Dr. Peter Ong and colleagues at the Robert-Bosch-Krankenhaus note that up to 30 per cent of patients with ACS who undergo angiography have no coronary artery obstruction.

To investigate how many chest pain patients might be experiencing coronary artery spasm, the team prospectively studied 488 patients with suspected ACS who required emergency room treatment.

In 138 (28 per cent), no culprit lesion could be identified. In 22 of these 138, chest pain was attributable to conditions such as myocarditis, cardiomyopathy, and pulmonary embolism.

In 86 of the remaining 116 patients, the authors attempted intracoronary provocation with acetylcholine. In 42 patients (49 per cent), coronary spasm was produced, along with "exactly the same chest pain."

"Coronary spasm is a frequent cause of ACS and should regularly be considered as a differential diagnosis," the researchers conclude.

In comments to Reuters Health, Dr. Carl J. Pepine, author of an accompanying editorial, agreed. "We are seeing increasing numbers of ACS patients without an obstructive lesion on angiography and we need to consider testing these cases for coronary spasm." Dr. Pepine is at the University of Florida, Gainesville.

J Am Coll Cardiol 2008;52:523-527,528-530