Coronary Spasm Following Myocardial Revascularization

pp 295-301

Abstract

Background Coronary spasm was proposed as the cause of early myocardial ischemia following coronary artery operation. The aim of this study was to determine the prevalence of coronary spasm in the postoperative period after coronary artery surgery. Method In a prospective and consecutive series, 13 out of 178 operated patients showed ST segment elevation associated with direct observation of spasm or evidence of permeability in native arteries and grafts by coronariography within 24 hours following the ischemic episode. Results In 8 patients electrocardiographic changes were accompanied by cardiac failure. In 10 patients, the ischemic episode and hemodynamic failure were reverted with the administration of intravenous nitroglycerine or through the grafts. In three patients, owing to the refractoriness of vasodilator therapy, an emergency coronariography was performed during the, episode and a reversible focal and diffuse spasm of the mammary artery or native arteries was observed. In the remaining patients, the hemodynamic study performed within the first 24 hours showed permeability of grafts as well as of native circulation. None of the patients had a history of Prinz metal angina and both pH determination and serum ionogram were normal prior to the episode. Conclusions Perioperatory coronary spasm after myocardial revascularization is a relatively frequent event (7%). Its presence in the grafts and native arteries and its generalized and diffuse characteristics seem to depend on the interaction between a powerful systemic stimulus andan exaggerated vasoconstrictor vascular response.