Eosinophilia and Coronary Artery Vasospasm

Chi Wing Wong, Sushil Luis, Irene Zeng, Ralph A.H. Stewart

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

Objective: To describe the clinical features, natural history and response to treatment of coronary vasospasm associated with eosinophilia. Methods: Two patients with eosinophilia who had recurrent acute coronary events due to multi-vessel coronary artery spasm are described. The clinical presentation and outcomes of these 2 patients and 17 additional cases of eosinophilia and coronary artery vasospasm identified on a systematic literature review are presented. Results: Patients were usually admitted because of repeated episodes of angina at rest and raised plasma markers of myocyte necrosis. Dynamic ST elevation was observed in 15 (83%) patients. Coronary angiography was performed in all patients. Spontaneous (n = 7) or provoked (n = 8) coronary artery spasm, which was usually multi-focal, was observed in 15 (83%) patients. Symptoms often continued despite high dose vasodilators but responded well to prednisone. Recurrent coronary events were frequent, and included sudden death (n = 4), resuscitated cardiac arrest (n = 2), myocardial infarction (n = 10) and unstable angina (n = 11). Recurrent events were more frequent when not taking compared to when taking prednisone (4.2 versus 0.4 events/year, p = 0.002, hazard ratio 11, 95% confidence interval 2.4-50). Conclusion: Published case reports suggest that coronary vasospasm associated with eosinophilia responds poorly to conventional vasodilator treatment and the risk of recurrent coronary events is high. Most patients respond to treatment which suppresses the eosinophilia.

Original languageEnglish (US)
Pages (from-to)488-496
Number of pages9
JournalHeart Lung and Circulation
Volume17
Issue number6
DOIs
StatePublished - Dec 1 2008

Keywords

  • Coronary arteritis
  • Coronary artery vasospasm
  • Eosinophilia

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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