Clinical Presentation and Treatment Response in Women With Acetylcholine-Confirmed Coronary Spasm: A Single-Center Observational Study.
J, S., R, K., M, T., MB, I., M, B., R, Z., & A, A. (2026). Clinical Presentation and Treatment Response in Women With Acetylcholine-Confirmed Coronary Spasm: A Single-Center Observational Study.. Clinical cardiology. https://doi.org/10.1002/clc.70424
J S, R K, M T, MB I, M B, R Z, et al. Clinical Presentation and Treatment Response in Women With Acetylcholine-Confirmed Coronary Spasm: A Single-Center Observational Study.. Clinical cardiology. 2026; doi: 10.1002/clc.70424
J S, R K, M T, et al. Clinical Presentation and Treatment Response in Women With Acetylcholine-Confirmed Coronary Spasm: A Single-Center Observational Study.[J]. Clinical cardiology. 2026. DOI: 10.1002/clc.70424.
@article{j2026,
author = {Sikulu J and Kubini R and Turkman M and Immohr MB and Becker M and Zayat R and Aljalloud A},
title = {Clinical Presentation and Treatment Response in Women With Acetylcholine-Confirmed Coronary Spasm: A Single-Center Observational Study.},
journal = {Clinical cardiology},
year = {2026},
doi = {10.1002/clc.70424},
note = {PMID: 42478585},
}
TY - JOUR AU - Sikulu J AU - Kubini R AU - Turkman M AU - Immohr MB AU - Becker M AU - Zayat R AU - Aljalloud A TI - Clinical Presentation and Treatment Response in Women With Acetylcholine-Confirmed Coronary Spasm: A Single-Center Observational Study. T2 - Clinical cardiology PY - 2026 DO - 10.1002/clc.70424 AN - PMID:42478585 ER -
BACKGROUND: Coronary 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. METHODS: This 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. RESULTS: A 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%). CONCLUSIONS: In 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.