Retrospective Cohort Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Sep 26, 2020; 12(9): 450-459
Published online Sep 26, 2020. doi: 10.4330/wjc.v12.i9.450
Clinical significance of prolonged chest pain in vasospastic angina
Hiroki Teragawa, Chikage Oshita, Yuichi Orita
Hiroki Teragawa, Chikage Oshita, Yuichi Orita, Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
Author contributions: Orita Y and Oshita C contributed to the acquisition of data; Teragawa H contributed to the writing and revision of the manuscript.
Institutional review board statement: This study was approved by the Institutional Review Board of Medical Corporation JR Hiroshima Hospital.
Informed consent statement: Informed consent was obtained from all of the patients.
Conflict-of-interest statement: None of the authors have any conflicts of interest to declare.
Data sharing statement: No additional data.
STROBE statement: The guidelines of the STROBE statement have been adopted.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Hiroki Teragawa, FACC, FACP, FAHA, MD, PhD, Chief Doctor, Department of Cardiovascular Medicine, JR Hiroshima Hospital, 3-1-36 Futabanosato, Higashi-ku, Hiroshima 732-0057, Japan.
Received: June 2, 2020
Peer-review started: June 28, 2020
First decision: June 15, 2020
Revised: June 28, 2020
Accepted: September 15, 2020
Article in press: September 15, 2020
Published online: September 26, 2020

Patients with vasospastic angina (VSA) sometimes experience prolonged chest symptoms. The clinical characteristics of these patients have not been clarified.


To investigate the clinical characteristics of prolonged VSA patients.


This study included 167 patients with VSA diagnosed by spasm provocation tests (SPTs) using acetylcholine, which recorded the frequencies of positive reactions to a low dose of acetylcholine (L-ACh), total occlusion due to spasm (TOC), focal spasm, and the unavoidable use of nitroglycerin (unavoidable-NTG) during SPTs. The patients underwent a medical interview that investigated the maximum duration and frequency of chest symptoms as well as the frequencies of variant angina and other serious symptoms. The patients were divided into two groups based on the maximal duration: The short-duration group (< 15 min; n = 114) and the long-duration group (≥ 15 min; n = 53). They were also divided into two groups based on the frequency of chest symptoms: The low-frequency group (< 4/mo; n = 88) and the high-frequency group (≥ 4/mo; n = 79).


The long-duration group showed higher frequencies of other serious symptoms (P < 0.001) and variant angina (P < 0.05) as well as higher frequencies of spasm induction by L-ACh (P < 0.05), TOC (P < 0.05), focal spasm (P < 0.01), and unavoidable-NTG (P < 0.01) than the short-duration group. These parameters did not differ significantly between the low-frequency and high-frequency groups.


These findings suggest that patients with VSA who experience prolonged chest symptoms may have more severe characteristics of VSA.

Keywords: Acetylcholine, Prolonged angina attacks, Variant angina, Vasospastic angina, Spasm provocation test, Prognosis

Core Tip: We have sometimes experienced patients with vasospastic angina (VSA) who had prolonged chest symptoms (≥ 15 min). We showed that such VSA patients had higher frequencies of other serious symptoms and variant angina as well as higher frequencies of spasm induction by a low dose of acetylcholine, total occlusion due to spasm, focal spasm, and unavoidable use of nitroglycerin in the spasm provocation test (SPT). On the other hand, the frequency of chest symptoms did not influence these findings in the SPT. Prolonged chest symptoms may be related to more severe characteristics of VSA.