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Coronary vasomotor abnormalities in patients with stable angina after successful stent implantation but without in-stent restenosis

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Abstract

Background

Coronary angiography is often performed in patients with recurrent or ongoing angina after successful percutaneous coronary intervention (PCI) in search of an in-stent restenosis (ISR). However, in many of these patients, no significant ISR can be detected. We speculate that enhanced coronary vasoconstriction represents an alternative explanation for angina in these patients.

Methods

From 1,285 patients with angiographically unobstructed coronaries (no stenosis ≥50 %) who underwent intracoronary acetylcholine provocation testing (ACH-test) between 2008 and 2011, we consecutively recruited 104 patients (42 female (40 %), mean age 64 ± 11 years) who fulfilled the following inclusion criteria: previous stent implantation due to obstructive coronary artery disease (CAD), ongoing/recurrent exertional angina, no significant (<50 %) ISR.

Results

In fifty-one patients with previous PCI (49 %), the ACH-test elicited enhanced epicardial vasoconstriction (≥75 % diameter reduction with reproduction of the patient’s symptoms) and microvascular vasoconstriction (reproduction of symptoms, ischemic ECG-changes and no epicardial vasoconstriction) was seen in 18 additional patients (17 %). The ACH-test was uneventful in the remaining 35 patients (34 %). Epicardial vasoconstriction in patients with previous PCI was most often distal and diffuse (31/51, 61 %, p < 0.01).

Conclusion

Enhanced epicardial and microvascular coronary vasoconstrictions are frequently found in patients with stable angina after successful PCI but without significant ISR. Intracoronary acetylcholine provocation testing may be useful in these patients to determine the cause of angina and initiate appropriate medical treatment.

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Abbreviations

ACH:

Acetylcholine

BMS:

Bare metal stent

CAD:

Coronary artery disease

DES:

Drug eluting stent

ECG:

Electrocardiogram

ISR:

In-stent restenosis

LCA:

Left coronary artery

RCA :

Right coronary artery

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Acknowledgments

The authors are grateful to nurses and technicians in the catheterization laboratories and to all staff members, especially Nathalie Konopka, of the Department of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany for their help and support during the study.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest

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Authors and Affiliations

  1. Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376, Stuttgart, Germany

    Peter Ong, Anastasios Athanasiadis, Andrea Perne, Heiko Mahrholdt, Tim Schäufele, Stephan Hill & Udo Sechtem

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  1. Peter Ong
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  2. Anastasios Athanasiadis
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  3. Andrea Perne
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  4. Heiko Mahrholdt
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  5. Tim Schäufele
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  6. Stephan Hill
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  7. Udo Sechtem
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Corresponding author

Correspondence to Peter Ong.

Additional information

P. Ong and A. Athanasiadis contributed equally to this study.

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Ong, P., Athanasiadis, A., Perne, A. et al. Coronary vasomotor abnormalities in patients with stable angina after successful stent implantation but without in-stent restenosis. Clin Res Cardiol 103, 11–19 (2014). https://doi.org/10.1007/s00392-013-0615-9

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  • DOI: https://doi.org/10.1007/s00392-013-0615-9

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