ACUTE MYOCARDIAL-ISCHEMIA IN SPONTANEOUS CORONARY-ARTERY SPASMS

Aim of study: To discover what factors indicate spontaneous coronary a rtery spasms as a cause of myocardial ischaemia. Patients and method: In. retrospective analysis 15 of 1407 consecutive patients who had und ergone coronary arteriography (six women and nine men; mean age 47 +/- 11 years) had acute ischaemia due to spontaneous coronary artery spas ms. The clinical findings at the time of first investigation and durin g the follow-up period (mean of 29 [3-65] months) were evaluated. Resu lts: The most common risk factors were hypercholesterolaemia (greater than or equal to 200 mg/dl) in ten patients (66%) and heavy nicotine c onsumption greater than or equal to 20 cigarettes per day) in eight pa tients (55%). Of the patients with angina at rest nine had reversible ST elevations, six had terminal T negativity in the ECG and an increas ed incidence of ventricular arrhythmias (n = 6). At time of hospitaliz ation ten patients had acute myocardial ischaemia and five had signs o f acute myocardial infarction (maximal creatine kinase concentration: 121-2980 U/1). Acute coronary angiography revealed circumscribed coron ary artery constriction, reversible with nitroglycerin, with stenosis of < 70% in five patients and of greater than or equal to 70% in six, as well as intermittent vessel occlusion in four patients. Angiography showed smooth coronary artery walls in almost most all instances. Ang iographic evidence of circumscribed arteriosclerotic lesion with maxim ally 50% narrowing was present in six patients. Conclusion: Especially in younger, male patients with hypercholesterolaemia and heavy smokin g recurrent anginal pectoris at rest, with reversible ECG signs of myo cardial ischaemia but without advanced coronary sclerosis, speaks for spontaneous coronary artery spasms as the cause.