Table 1.
Diagnostic criteria for microvascular angina and vasospastic angina by the Coronary Vasomotion Disorders International Study Group
| Criteria | Microvascular angina | Vasospastic angina |
|---|---|---|
| 1. Symptoms of myocardial ischemia |
(a) Effort and/or rest angina (b) Angina equivalents (i.e., shortness of breath) |
Nitrate-responsive angina during spontaneous episode, with at least one of the following: (a) Rest angina - especially between night and early morning (b) Marked diurnal variation in exercise tolerance - reduced in morning (c) Hyperventilation can precipitate an episode (d) Calcium channel blockers (but not beta-blockers) suppress episodes |
| 2. Absence of obstructive CAD (<50% diameter reduction or FFR<0.80) |
(a) Coronary CTA (b) Invasive coronary angiography |
(a) Coronary CTA (b) Invasive coronary angiography |
| 3. Objective evidence of myocardial ischemia | (a) Ischemic ECG changes during an episode of chest pain (b) Stress-induced chest pain and/or ischemic ECG changes in the presence or absence of transient/reversible abnormal myocardial perfusion and/or wall motion abnormality |
Transient ischemic ECG changes during spontaneous episode, including any of the following in at least two contiguous leads: (a) ST segment elevation ≥0.1 mV (b) ST segment depression ≥0.1 mV (c) New negative U waves |
| 4. Evidence of coronary dysfunction |
(a) Impaired coronary flow reserve (cut-off values depending on methodology use between ≤2.0 and ≤2.5) (b) Coronary microvascular spasm, defined as reproduction of symptoms, ischemic ECG shifts but no epicardial spasm during acetylcholine testing. (c) Abnormal coronary microvascular resistance indices (e.g., IMR >25) (d) Coronary slow flow phenomenon, defined as TIMI frame count >25. |
Coronary artery spasm 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) |
“Definitive” if all four criteria are present while “suspected” if criteria 1 and 2 are met but only criteria 3 or 4 is present or equivocal. ECG Electrocardiogram, CAD coronary artery disease, CTA computed tomographic angiography, FFR fractional flow reserve, IMR index of microcirculatory resistance, TIMI thrombolysis in myocardial infarction