Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.
When coronary spasm reflects systemic vascular disease: Prognostic insights from endothelial dysfunction
Nikolaos Ktenopoulos, Anastasios Apostolos, Konstantinos Tsioufis, Konstantinos Toutouzas, First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Athens 11527, Greece
Nikias Milaras, Skevos Sideris, Department of Cardiology, “Hippokration” General Hospital, Athens 11527, Greece
Author contributions: Ktenopoulos N and Milaras N contributed to conceptualization and writing - original draft preparation; Apostolos A, Tsioufis K, Toutouzas K, and Sideris S contributed to writing - review and editing. All authors have read and agreed to the published version of the manuscript.
AI contribution statement: The AI-assisted tool ChatGPT was used only to support language polishing, editing for clarity, grammar, readability and organization of the text. AI-assisted tools were used only for language polishing and writing assistance, including improving grammar, phrasing, readability and clarity. No AI tool was used for statistical analysis, data analysis, generation of results, or creation of scientific conclusions.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Corresponding author: Nikias Milaras, MD, First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital of Athens, Vasilisis Sofias 14, Athens 11527, Greece. nikiasmilaras@gmail.com
Received: February 24, 2026
Revised: April 10, 2026
Accepted: May 13, 2026
Published online: August 26, 2026
Processing time: 191 Days and 1.6 Hours
Revised: April 10, 2026
Accepted: May 13, 2026
Published online: August 26, 2026
Processing time: 191 Days and 1.6 Hours
Core Tip
Core Tip: In patients with vasospastic angina, impaired brachial artery flow-mediated dilation independently predicts adverse cardiovascular events and outperforms conventional angiographic spasm markers. These data support the concept that coronary spasm reflects systemic endothelial pathology rather than isolated epicardial hyperreactivity, highlighting the potential role of endothelial function testing in clinical risk stratification.