Observational studyClinical cardiology2026
Clinical Presentation and Treatment Response in Women With Acetylcholine-Confirmed Coronary Spasm: A Single-Center Observational Study.
Observational study in Clinical cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
7 authors.
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Abstract
backgroundCoronary vasomotor disorders are frequently underdiagnosed in women with angina and non-obstructive coronary arteries. We investigated clinical presentation, diagnostic delay, spasm subtype, and patient-reported treatment response in women with acetylcholine-confirmed coronary spasm.
methodsThis single-center observational study included women with a positive intracoronary acetylcholine provocation test who completed a locally developed questionnaire on symptoms, triggers, comorbidities, medication tolerance, and treatment response. Epicardial spasm was defined as ≥ 90% epicardial diameter reduction with symptom reproduction and ischemic ECG changes; microvascular spasm as symptoms and ischemic ECG changes with < 90% epicardial vasoconstriction. Diltiazem was initiated as first-line therapy, with amlodipine as an alternative. Regression analyses exploring therapeutic failure were considered exploratory because of the low event count.
resultsA total of 194 women were included (median age 60 years [IQR 52-67]). Chest pain/tightness was reported by 163/190 (85.8%), dyspnea by 70/135 (51.9%), and palpitations by 74/136 (54.1%). Epicardial/microvascular spasm was present in 110/187 (58.8%) and 77/187 (41.2%). Median symptom-to-diagnosis time was 24 months [IQR 8-90]. Diltiazem was prescribed in 162/194 (83.5%). Among respondents with follow-up data, symptom frequency decreased in 103/128 (80.5%), episode duration decreased in 91/118 (77.1%), and pain intensity decreased/resolved in 92/115 (80.0%). Therapeutic failure occurred in 8/106 (7.5%). Residual symptom burden remained common, with CCS class > II at follow-up in 65/124 (52.4%) and persistent complaints in 53/107 (49.5%).
conclusionsIn women with acetylcholine-confirmed coronary spasm, symptom burden and diagnostic delay were substantial. Calcium-channel blocker therapy was associated with patient-reported symptom improvement among respondents with available follow-up data.
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