Vasospastic angina: Pathophysiology, diagnosis, and emerging therapeutic approaches

Table 1 Coronary vasomotion disorders international study group criteria for diagnosis of vasospastic angina

COVADIS criteria for diagnosing vasospastic angina[14]
1 Nitrate responsive angina during spontaneous episode, with at least one of the following:
Rest angina – especially between night and early morning
Marked diurnal variation in exercise tolerance – reduced in morning
Hyperventilation can precipitate an episode
Calcium-channel blockers (but not -blockers) suppress episodes
2 Transient ischemic ECG changes during spontaneous episode, including any of the following in at least two contiguous leads:
ST segment elevation 0.1 mV
ST segment depression 0.1 mV
New negative U waves
3 Coronary artery spasm on invasive coronary angiography, defined as transient total or subtotal coronary artery occlusion (> 90% constriction) with angina and ischemic ECG changes, either spontaneously or in response to a provocative stimulus (typically acetylcholine, ergot, or hyperventilation)
Definite VSA: Criteria 1 + either criterion 2 or criteria 3 are fulfilled
Suspected VSA: Criteria 1 fulfilled but Criteria 2 is equivocal or unavailable, and Criteria 3 is equivocal

Coronary Vasomotion Disorders International Study Group criteria for diagnosing vasospastic angina. COVADIS: Coronary Vasomotion Disorders International Study Group; ECG: Electrocardiogram.