Diagnostic Criteria for Vasospastic Angina (VSA)

Vasospastic angina (VSA) is a variant form of angina pectoris, in which angina occurs at rest, with transient electrocardiogram modifications and preserved exercise capacity. VSA can be involved in many clinical scenarios, such as stable angina, sudden cardiac death, acute coronary syndrome, arrhythmia or syncope.

Diagnostic Criteria for Vasospastic Angina (VSA)

Vasospastic angina diagnostic criteria elements

1. Nitrate-responsive angina-during spontaneous episode, with at least one of the following:
   1. Rest angina-especially between night and early morning
   2. Marked diurnal variation in exercise tolerance-reduced in morning
   3. Hyperventilation can precipitate an episode
   4. Calcium channel blockers (but not β-blockers) suppress episodes
2. Transient ischaemic ECG changes-during spontaneous episode, including any of the following in at least two contiguous leads:
   1. ST segment elevation ≥0.1 mV
   2. ST segment depression ≥0.1 mV
   3. New negative U waves
3. Coronary artery spasm-defined as transient total or subtotal coronary artery occlusion (>90% constriction) with angina and ischaemic ECG changes either spontaneously or in response to a provocative stimulus (typically acetylcholine, ergot, or hyperventilation)

Definitive vasospastic angina’ is diagnosed if nitrate-responsive angina is evident during spontaneous episodes and either the transient ischaemic ECG changes during the spontaneous episodes or coronary artery spasm criteria are fulfilled.

Suspected vasospastic angina’ is diagnosed if nitrate-responsive angina is evident during spontaneous episodes but transient ischaemic ECG changes are equivocal or unavailable and coronary artery spasm criteria are equivocal.

 

References:

1. Beltrame JF, Crea F, Kaski JC, Ogawa H, Ong P, Sechtem U, Shimokawa H, Bairey Merz CN; Coronary Vasomotion Disorders International Study Group (COVADIS). International standardization of diagnostic criteria for vasospastic angina. Eur Heart J. 2017 Sep 1;38(33):2565-2568. [Medline]
2. Picard F, Sayah N, Spagnoli V, Adjedj J, Varenne O. Vasospastic angina: A literature review of current evidence. Arch Cardiovasc Dis. 2019 Jan;112(1):44-55. [Medline]

 

Created Aug 29, 2019.