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Artery Stenosis and Vasospastic Angina
Vasospastic angina (VA) is caused by focal or diffuse spasm of an epicardial coronary artery, resulting in severe obstruction of the coronary artery lumen and myocardial ischemia. Vasospasm can occur in an angiographically normal coronary artery, but may also occur at the site of an existing organic atherosclerotic stenosis. Stable atherosclerotic plaques are rarely fatal, but can interfere with coronary blood flow and lead to stable angina. However, it has been suggested that vasospasm is associated with endothelial damage and subsequent atheroma rupture. Considering that acute coronary syndrome (ACS) is almost always caused by luminal thrombus or sudden plaque rupture applied to organic atherosclerotic plaques, coronary vasospasm can induce the rupture of a stable atheroma, which could lead to myocardial infarction and sudden cardiac death.
Vasospastic angina (VA) is a functional disease of the coronary artery and occurs in an angiographically normal coronary artery. However, it may also occur with coronary artery stenosis. We investigated the effect of coronary artery stenosis on clinical outcomes in VA patients. Study data were obtained from a prospective multicenter registry that included patients who had symptoms of VA. Patients were classified into two groups according to presence of significant coronary artery stenosis. Among 1920 patients with VA, 189 patients were classified in the “significant stenosis” group. The one-year composite clinical events rate was significantly higher in the significant stenosis group than in the “no significant stenosis” group (5.8% vs. 1.4%, respectively; p < 0.001). Additionally, the prevalence of ACS was significantly greater in the “significant stenosis” group (4.8% vs. 0.9%, respectively; p < 0.001). After propensity score matching, the adverse effects of significant stenosis remained. In addition, significant stenosis was independently associated with a 6.67-fold increased risk of ACS in VA patients. In conclusion, significant coronary artery stenosis can increase the adverse clinical outcomes in VA patients at long-term follow-up. Clinicians should manage traditional risk factors associated with atherosclerosis and control vasospasm as well as reduce the burden of atherosclerosis.
2. Vasospastic Angina
The entry is from 10.3390/jcm10153341
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