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We read with great interest the article by Baccouche et al.1 In line with previous studies,2,3 the authors confirm that in the absence of significant coronary artery disease, myocarditis is the most frequent diagnosis of troponin-positive patients with acute chest pain. However, coronary artery spasm is also very common in these patients and, as the authors acknowledge, the lack of spasm provocative test in their series is a limitation.

We have recently published the data of the VIRIATO (Vasospasm Incidence Registered after Investigation with Angiography and Tested Objectively with ergonovine) registry that included 346 consecutive patients of our centre with acute chest pain and no significant coronary artery disease.4 If we focus on the 187 patients with troponin-T elevation, 64 patients (34.2%) presented coronary spasm. In 42 patients (22.5%), this diagnosis was confirmed with a spasm provocative test, and in 22 patients (11.8%) was based on chest pain characteristics, ECG changes during chest pain (ST-segment elevation), and a rapid resolution with sublingual nitroglycerin. Other diagnosis mentioned by Baccouche et al., such as Tako-Tsubo cardiomyopathy, was less frequent in VIRIATO patients with troponin-T elevation. In fact, only 19 patients (9.1%) presented Tako-Tsubo cardiomyopathy.5

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