Coronary Artery Spasm in Multivessel ACS: What More Should We Know?

Coronary spasm may present as acute coronary syndrome (ACS), "which can be an ST segment elevation myocardial infarction (STEMI), non-STEMI, or unstable angina." However, the prevalence of coronary spasm in patients with ACS remains unknown due to scarcity of data. Concomitant coronary spasm may mask the true atherosclerosis burden in such cases, posing several management challenges. We illustrate the case of managing an ACS patient with concomitant spasm and atherosclerotic disease. We show that the routine use of vasodilator treatment in ACS cases may prevent inappropriate stenting by identifying concomitant coronary spasm, influencing the clinical outcomes associated with inappropriate stenting in the setting of coronary spasm.