Coronary artery spasm-related acute coronary syndrome in patients with coexisting spasm of angiographically normal coronary artery and fixed narrowing of the remaining vessels

Fourteen patients with acute coronary syndrome are presented in this study. During angiography, hemodynamically significant coronary artery disease was demonstrated; however, it was not consistent with the electrocardiographic findings. The coronary artery spasm could be provoked in the rest of the angiographically normal coronary artery. Patient chest pain disappeared after administration of calcium channel blockers and/or isosorbide dinitrite. It is suggested that (1) both coronary artery spasm with no fixed stenosis and coronary atherosclerosis with fixed coronary stenosis can coexist in the same patient and cause symptoms, and (2) it is important to identify the predominant cause of symptoms, which then guides correct management.