Study on 154 patients with chest pain, mean age: 61 years old, males accounted for 65%. Most common risk factors were hypertension 74%, high serum cholesterol level 60.4%, smoking 47.4%, diabetes 19.5%, family history 30.5%. B-mode ultrasonographic findings were normal carotid arteries in 22 patients (14.3%), intima-media thickness (IMT) >0.7 mm in 132 patients (85.7%), plaques of unilateral carotid arteries in 77 patients (50%), and plaques of bilateral carotid arteries in 36 patients (23.4%). There was a correlation between the IMT, the plaques of carotid arteries and the ages
Atherosclerosis, chest pain, angina pectoris

BACKGROUND AND OBJECTIVES: The therapeutic duration of variant angina is controversial. This study sought to determine the remission rates for coronary artery spasms, the factors associated with remission and the changes in spasm sites. SUBJECTS AND METHODS: Fifty-eight patients were enrolled in the study. Initial, and follow-up, coronary angiographies (CAG), with ergonovine stimulation tests, were performed. Paired CAG were performed at a mean interval of 27+/-17 months. Medication was stopped 3 days prior to the follow-up CAG, and the occurrence of chest pain during these 3 days was studied. Coronary spasms were confirmed by follow-up CAG. Any changes, and the diameters, of spasm sites were analyzed on each paired CAG. RESULTS: The remission rate of coronary spasms was 24% (14 patients), when the smoking group (49 patients) stopped smoking (31 patients), the remission rate was 29% (9 patients). In the current smoking group (18 patients), the remission rate was 6% (1 patient, p=0.05). 31 patients had chest pains after stopping medication prior to their follow-up CAG. Of those patients, 1 patient had a remission (3%). Among another 27 patients with no chest pain, 13 patients had a remission (48%, p<0.001). In 28 out of 44 patients (64%, non-remission), fluctuations in spastic locations were observed at the follow-up CAG. The interval changes in the diameter of the spasm sites were not significant. CONCLUSION: The non-chest pain group showed higher remission rates, but lack of chest pain did not identify the loss of coronary spasm. Atherosclerosis at spasm sites did not progress, as confirmed by the paired CAG in our study.
Angina Pectoris, Variant ; Atherosclerosis ; Chest Pain ; Coronary Angiography* ; Coronary Artery Disease ; Coronary Vessels ; Ergonovine ; Follow-Up Studies* ; Humans ; Muscle Spasticity ; Smoke ; Smoking ; Spasm*

BACKGROUND AND OBJECTIVES: Plasma adiponectin, which decreases the progression of atherosclerosis and insulin resistance, as well as suppressing lipid accumulation in macrophages, is decreased in patients with acute myocardial infarction and unstable angina pectoris; however, the correlation between plasma adiponectin and vasospastic angina pectoris (VAP) remains to be verified. We compared the plasma adiponectin concentration between patients with VAP and other coronary artery diseases; moreover, we investigated the association between the plasma adiponectin concentration and VAP. SUBJECTS AND METHODS: Following coronary angiography for the evaluation of chest pain, 395 subjects (180 women and 215 men) were divided into 4 groups: acute coronary syndrome (ACS)(n=117), VAP (n=94), stable angina pectoris (SAP)(n=108) and angiographically normal coronary artery (n=76). The acetylcholine provocation test was used to confirm VAP, and plasma adiponectin concentrations were measured in all participants. RESULTS: The plasma adiponectin concentrations in patients with VAP and ACS were significantly lower than that of the normal coronary artery group (6.6+/-5.4 vs. 5.2+/-4.0 vs. 9.0+/-6.2 microgram/mL, p<0.001, respectively). A multivariate analysis indicated that plasma adiponectin [odd ratio (OR) 0.744, 95% confidence interval (CI) 0.645 to 0.858, p=0.001], smoking (OR 2.054, 95% CI 1.027 to 4.106, p=0.042) and age (OR 0.966, 95% CI 0.935 to 0.997, p=0.031) were independently correlated in patients diagnosed with VAP. CONCLUSION: Our results suggest that a decreased plasma adiponectin concentration may be associated with VAP.
Acetylcholine ; Acute Coronary Syndrome ; Adiponectin* ; Angina Pectoris ; Angina, Stable ; Angina, Unstable ; Atherosclerosis ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vasospasm ; Coronary Vessels ; Female ; Humans ; Insulin Resistance ; Macrophages ; Multivariate Analysis ; Myocardial Infarction ; Plasma* ; Smoke ; Smoking

Variant angina pectoris (VAP) is a special type of unstable angina with coronary artery spasm as the main pathogenesis, characterized by resting chest pain, and transient ST segment dynamic changes. The development of acute myocardial infarction is not uncommon. We report a case of a 49-year-old female patient diagnosed with VAP at 2 years before who suddenly suffered severe chest pain. Troponin-I was elevated. Immediate coronary angiography showed near-total occlusion in the proximal left anterior descending artery, which was not fully dilated despite use of intracoronary nitroglycerin. Intravascular ultrasound showed focal significant stenosis with a large amount of plaque at the site of spasm and the lesion was successfully treated with drug-eluting stent placement. Intravascular imaging may be instrumental in high-risk patients with VAP who suffer recurrent chest pain despite intensive anti-spasm medications.
Angina Pectoris, Variant ; Angina, Unstable ; Arteries ; Atherosclerosis* ; Chest Pain ; Constriction, Pathologic ; Coronary Angiography ; Coronary Vessels ; Drug-Eluting Stents ; Female ; Humans ; Middle Aged ; Myocardial Infarction* ; Nitroglycerin ; Spasm* ; Troponin I ; Ultrasonics ; Ultrasonography

Coronary vessel anomaly is a rare disease, with an incidence of about 0.6-1.3% of patients receiving coronary angiography. The ischemia in coronary vessel anomalies is due in most cases to atherosclerosis or compression of the coronary artery by a great vessel, but occasionally spasm of a coronary vessel anomaly is responsible for the pathogenesis of chest pain and myocardial ischemia. A 64-year-old female presented with a one-year history of effort angina. The left circumflex artery originated from the proximal right coronary artery. There was no atherosclerotic lesion in the right and left coronary arteries, but a focal spasm in the right coronary artery by ergonovine. In a patient with chest pain and coronary artery anomaly, if there is no coronary atherosclerosis, abnormal course or compression, the spasm test of the coronary artery should be documented.
Angina Pectoris, Variant ; Arteries* ; Atherosclerosis ; Chest Pain ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessel Anomalies* ; Coronary Vessels* ; Ergonovine ; Female ; Humans ; Incidence ; Ischemia ; Middle Aged ; Myocardial Ischemia ; Rare Diseases ; Spasm