Sensitivity and specificity of intracoronary injection of acetylcholine for the induction of coronary artery spasm

Aim and Objective: To estimate the relationship between Coronary Calcium Scoring (CCS)and presence of different degrees of obstructive coronary artery disease (CAD) to avoid unnecessary examinations and hence unnecessary radiation exposure and contrast injection. Background: Coronary Calcium Scoring (CCS) is a test uses x-ray equipment to produce pictures of the coronary arteries to determine the degree of its narrowing by the build-up of calcified plaques. Despite the lack of definitive data linking ionizing radiation with cancer, the American Heart Association supports widely that practitioners of Computed tomography Coronary Angiography (CTCA) should keep “patient radiation doses as low as reasonably achievable but consistent with obtaining the desired medical information”. Methods: Data obtained from 275 CTCA examinations were reviewed. Radiation effective doses were estimated for both CCS and CTCA, measures to keep it as low as possible were presented, CCS and Framingham risk estimate were compared to the final results of CTCA to detect sensitivity and specificity of each one in detecting obstructive lesions. Results: CCS is a strong discriminator for obstructive CAD and can with high sensitivity and specificity and correlates well with the degree of obstruction even more than Framingham risk estimate which has high sensitivity and low specificity. Conclusion: CCS helps reducing the effective radiation dose if properly evaluated to skip unnecessary CTCA if obstructive lesions was unlikely, and as a test does not use contrast material, harmful effect on the kidney will be avoided as most of coronary atherosclerotic patients have renal problems.

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Enhanced Myosin Light Chain Phosphorylations as a Central Mechanism for Coronary Artery Spasm in a Swine Model With Interleukin-1β

Circulation ◽

10.1161/01.cir.96.12.4357 ◽

1997 ◽

Vol 96 (12) ◽

pp. 4357-4363 ◽

Cited By ~ 91

Author(s):

Naoki Katsumata ◽

Hiroaki Shimokawa ◽

Minoru Seto ◽

Toshiyuki Kozai ◽

Tohru Yamawaki ◽

...

Keyword(s):

Coronary Artery ◽

Light Chain ◽

Myosin Light Chain ◽

Coronary Artery Spasm ◽

Central Mechanism ◽

Interleukin 1Β ◽

Swine Model

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OCT Findings in MINOCA

Journal of Clinical Medicine ◽

10.3390/jcm10132759 ◽

2021 ◽

Vol 10 (13) ◽

pp. 2759

Author(s):

Krzysztof Bryniarski ◽

Pawel Gasior ◽

Jacek Legutko ◽

Dawid Makowicz ◽

Anna Kedziora ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Imaging Modality ◽

Obstructive Coronary Artery Disease ◽

Coronary Artery Spasm ◽

Morphological Characteristics ◽

Artery Dissection ◽

Plaque Disruption ◽

Artery Disease

Myocardial infarction with non-obstructive coronary artery disease (MINOCA) is a working diagnosis for patients presenting with acute myocardial infarction without obstructive coronary artery disease on coronary angiography. It is a heterogenous entity with a number of possible etiologies that can be determined through the use of appropriate diagnostic algorithms. Common causes of a MINOCA may include plaque disruption, spontaneous coronary artery dissection, coronary artery spasm, and coronary thromboembolism. Optical coherence tomography (OCT) is an intravascular imaging modality which allows the differentiation of coronary tissue morphological characteristics including the identification of thin cap fibroatheroma and the differentiation between plaque rupture or erosion, due to its high resolution. In this narrative review we will discuss the role of OCT in patients presenting with MINOCA. In this group of patients OCT has been shown to reveal abnormal findings in almost half of the cases. Moreover, combining OCT with cardiac magnetic resonance (CMR) was shown to allow the identification of most of the underlying mechanisms of MINOCA. Hence, it is recommended that both OCT and CMR can be used in patients with a working diagnosis of MINOCA. Well-designed prospective studies are needed in order to gain a better understanding of this condition and to provide optimal management while reducing morbidity and mortality in that subset patients.

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