Search
Close
Search
Advanced Search
Search Menu
AI Discovery Assistant

Extract

We would like to thank Martinez-Selles et al. for their interest in our study1 and also to congratulate these authors on their VIRIATO registry which focuses on the incidence of coronary spasm in patients with chest pain but no significant coronary artery disease (CAD).2 We absolutely agree with the remark of these authors suggesting that (i) coronary spasm needs to be considered as a potential cause for troponin elevation in patients with acute chest pain but no significant CAD and (ii) provocative testing (e.g. using intravenous ergonovine or intracoronary acetylcholine) should be performed in order to evaluate the presence of coronary spasm. This important issue is a limitation of our retrospective study.

The results of these authors' VIRIATO registry are in line with the study of Wang et al.3 who performed ergonovine provocation testing in 93 patients with unstable angina but no significant CAD: coronary spasm as the underlying cause of chest pain was detected in 41% of those 93 patients and considering the subgroup of patients with positive troponin (23/93), even in 74%. Moreover, our group has recently published intracoronary provocative testing results in 86 patients with acute chest pain but no significant CAD4: in 49% of these patients, coronary spasm was documented by intracoronary acetylcholine testing, thereby concluding that coronary spasm should be regularly considered as a differential diagnosis in such patients. Consequently, in the meantime, intracoronary provocative testing is recommended (Class IIa) in the ESC guidelines on the management of angina pectoris in order to identify coronary spasm in patients with appropriate clinical symptoms but no significant CAD.5

Issue Section:
Letters to the Editor
You do not currently have access to this article.
Download all slides