Acute Coronary Syndromes (ACS)
Session number: 179
Session title: Mechanisms and outcome of vasospastic angina
Authors: Hisao Ogawa (Kumamoto, Japan)
- Pathogenetic mechanisms. Presented by H Shimokawa (Sendai, JP)
- Diagnostic challenges. Presented by U Sechtem (Stuttgart, DE)
- Therapeutic challenges. Presented by Y Ozaki (Toyoake, JP)
- Long-term outcome. Presented by J C Kaski (London, GB)
This Clinical Seminar will provide new information on mechanisms, diagnosis and treatment of coronary spasm, a frequently neglected but important mechanism of disease. Indeed, coronary spasm plays a key role in vasospastic angina and an important role in all acute coronary syndromes. Furthermore, not rarely, it is refractory to current therapeutic approaches.
Dr. Shimokawa lectured the pathogenetic mechanism of coronary spasm. He explained that inflammation is important in the mechanism, and the importance of Rho-kinase. He explained that coronary spasm is related not only to vasospastic angina, acute coronary syndrome but also coronary artery treated with drug-eluting stents.
Dr. Sechtem talked about the diagnostic challenges, especially Acetylcholine testing. He pointed out that the importance of coronary spasm in acute coronary syndrome in Caucasian patients.
Dr. Ozaki presented the therapeutic challenges. He presented that coronary spasm is more frequent in Asians than in Caucasians, the therapy of calcium channel blockers, statins is effective, there is the fluctuation of spasm in terms of location in the coronary artery, limitations of percutaneous coronary intervention exist.
Dr. Kaski explained the long-term prognosis, and pointed out that acute myocardial infarction and sudden death are observed in 10-20% of the patients with coronary spasm. He further emphasized the problems of the out-of-hospital cardiac death and the indications of implanted cardiac defibrillators.
This Seminar is very important in the point that coronary spasm is discussed in the European Cardiac Society (ESC).
The content of this article reflects the personal opinion of the
author/s and is not necessarily the official position of the
European Society of Cardiology.