Coronary vasospasm and future percutaneous coronary intervention: relax

A clinical diagnosis of suspected angina that is accompanied by non- obstructive epicardial coronary artery disease is not uncommon, as evidenced by results from contemporary registries and trials of anatomical testing in chest pain. The basket labelled as angina with non-obstructive coronary artery disease (ANOCA—the clinical syndrome that may or may not accompany ischaemia with non- obstructive coronary artery disease (INOCA)) contains heterogeneous patho-physiological entities which vary in clinical presentation and adjunctive investigation findings. 1 One distinct entry in this field is vasospastic angina, a dynamic phenomenon with characteristic symptoms that differ from those induced by fixed epicardial coronary artery stenoses. Although the seminal case series which provided the eponymous nomen-clature for this clinical syndrome was published well before many (probably most) readers of Heart were born, attempts to codify and standardise defini-tions for vasospastic angina have only recently been promulgated. 2 The syndrome is seen in only a small propor-tion of patients with chest pain, with correspondingly limited sections in current guidelines. 3 4 The diagnostic process can be difficult and the clinical course uncertain. The latter is salient, events. 5