Stress Testing in Patients with Coronary Spasm: Comparison of Those With and Without Fixed Coronary Artery Disease

Stress testing is one of the preferred noninvasive methods of identifying patients with coronary artery disease (CAD). Its value in patients with coronary artery spasm (CAS) is, however, difficult to ascertain.The authors studied 91 consecutive patients with angiographically documented CAS. All patients underwent a symptom-limited bicycle exercise test before coronary angiography. Eight patients (8.8%) showed ST-segment elevation during exercise; 37 (40.7%), ST-segment depression; and 46 (50.5%), no changes. Thirty patients had normal coronary arteries; 19, one-vessel disease ; 19, two-vessel disease; and 23, three-vessel disease.Stress testing yielded abnormal results in 7 of 30 patients (23%) with no CAD and in 38 of 61 (62%) with fixed CAD (p < 0.01).ST-segment response to exercise did not correlate with most clinical findings such as age, type of angina, duration of pain episodes, or the degree of disease activity. However, a significant correlation was found with the extent and severity of CAD. Absen...