Angiographic presentation of coronary artery spasm in heart transplant recipients

We describe the angiographic characteristics of coronary artery spasm obser ved in 12 out of 247 (4.9%) patients who underwent 808 coronary angiographi es after heart transplantation. Coronary artery spasm was diagnosed when lo calized and reversible narrowing of the coronary lumen was identified. Afte r coronary artery spasm identification all patients were followed-up clinic ally for a mean period of 5.1 years. Coronary artery spasm was documented 1 -3 years after heart transplant. Coronary artery spasm affected 1 main coro nary artery in 10 patients and 2 in 2 patients; in 3 patients 1 or more sec ondary branches were also affected. The right coronary artery was affected by coronary artery spasm in 8 patients and the anterior descending coronary artery in 6 patients. In 6 patients coronary artery spasm was mechanically induced by the catheter tip. The degree of luminal narrowing due to corona ry artery spasm ranged from mild to almost complete occlusion. Coronary art ery spasm appeared as a single tubular smooth and concentric stenosis ih 8 patients, was discrete in 2 patients and multiple on the same vessel in 2 p atients. In 1 patient coronary artery spasm was erroneously interpreted as an organic lesion and percutaneous transluminal coronary angioplasty was pl anned. During follow-up 3 patients out of 4 who had shown multiple coronary artery spasm died and 2 patients developed critical organic stenosis. In c onclusion coronary artery spasm after heart transplant is less rare than co mmonly believed. Although it usually has a peculiar appearance, it can be m isinterpreted as an organic lesion. Multiple coronary artery spasm appears to carry a poor prognosis. (C) 2000 Elsevier Science Ireland Ltd. All right s reserved.