Features of atherosclerosis in patients with angina and no obstructive coronary artery disease

EuroIntervention 2022;18:e397-e404. DOI: 10.4244/EIJ-D-21-00875

Dario Pellegrini1,2, MD; Regina Konst1, MD; Stijn van den Oord1, MD, PhD; Aukelien Dimitriu-Leen1, MD, PhD; Jan-Quinten Mol1, MD; Tijn Jansen1, MD; Angela Maas1, MD, PhD; Helmut Gehlmann1, MD; Robert-Jan van Geuns1, MD, PhD; Suzette Elias-Smale1, MD, PhD; Niels van Royen1, MD, PhD; Peter Damman1, MD, PhD

1. Radboud University Medical Center, Department of Cardiology, Nijmegen, the Netherlands; 2. Aziende Socio Sanitarie Territoriale Papa Giovanni XXIII, Bergamo, Italy


An association between atherosclerosis and coronary vasospasm has previously been suggested. However, to date, no conclusive data on the whole spectrum of these disorders have been published.


This study aimed to define specific morphological features of atherosclerosis in patients with angina and no obstructive coronary artery disease (ANOCA) due to coronary vasospasm.


From February 2019 to January 2020, we enrolled 75 patients referred to our laboratory for a coronary function test (CFT) due to ANOCA and suspected coronary vasomotor dysfunction. The CFT consisted of an acetylcholine test and a physiology assessment with hyperaemic indexes using adenosine. Patients were divided into two groups according to the presence or absence of coronary vasospasm triggered by acetylcholine (ACH+ and ACH–, respectively). In addition, optical coherence tomography (OCT) was performed to assess the lipid index (LI), a surrogate for lipid area, and the prevalence of markers of plaque vulnerability.


ACH+ patients had a higher LI than ACH- patients (LI: 819.85 [460.95-2489.03] vs 269.95 [243.50-878.05], respectively, p=0.03), and a higher prevalence of vulnerable plaques (66% vs 38%, p=0.04). Moreover, ACH+ patients showed a higher prevalence of neovascularisation compared to ACH- subjects (37% vs 6%, p=0.02) and a trend towards a higher prevalence of all individual markers, in particular thin-cap fibroatheroma (20% vs 0%, p=0.06). No differences were detected between patterns of coronary vasospasm.


The presence of coronary vasospasm, regardless of its phenotype, is associated with higher lipid burden, plaque vulnerability and neovascularisation.


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Authors: Dario Pellegrini, Regina Konst, Stijn van den Oord, Aukelien Dimitriu-Leen, Jan-Quinten Mol, Tijn Jansen, Angela Maas, Helmut Gehlmann, Robert-Jan van Geuns, Suzette Elias-Smale, Niels van Royen, Peter Damman

Publication: EuroIntervention

Publisher: EuroIntervention

Date published: August 8th, 2022


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