What the study found
The study found that isolated spasm of the left anterior descending artery, a major heart artery, caused a large anterior myocardial infarction in a patient whose coronary angiogram showed no obstructive disease. Cardiac magnetic resonance imaging localized the infarct, and optical coherence tomography confirmed epicardial spasm and excluded other causes such as plaque rupture, erosion, thrombus, and spontaneous coronary artery dissection.
Why the authors say this matters
The authors suggest that coronary artery spasm is an under-recognized cause of myocardial infarction with non-obstructive coronary arteries, or MINOCA, a term for heart attack without a blocked major artery seen on angiography. They also conclude that early cardiac magnetic resonance imaging and intravascular imaging can help identify the cause and guide treatment.
What the researchers tested
This was a case report of a 48-year-old woman who presented with angina, dyspnea, hypotension, elevated troponin, anterior T-wave inversion on ECG, and severe regional wall-motion abnormalities on echocardiography. She then underwent angiography, cardiac magnetic resonance imaging, and optical coherence tomography to define the cause of her myocardial infarction.
What worked and what didn't
Angiography showed non-obstructive coronary arteries, so it did not identify a blocked vessel. Cardiac magnetic resonance imaging localized a large acute infarct in the left anterior descending artery territory, and optical coherence tomography demonstrated LAD spasm while excluding plaque rupture, erosion, thrombus, and spontaneous coronary artery dissection.
What to keep in mind
This is a single case report, so the findings describe one patient rather than a broader group. The abstract does not provide longer-term outcomes, and treatment was limited by vasospasm and hypotension.
Key points
- A 48-year-old woman had an acute anterior myocardial infarction linked to isolated left anterior descending artery spasm.
- Coronary angiography showed non-obstructive coronary arteries.
- Cardiac magnetic resonance imaging localized a large infarct in the left anterior descending artery territory.
- Optical coherence tomography identified LAD spasm and excluded plaque rupture, erosion, thrombus, and spontaneous coronary artery dissection.
- The authors describe coronary artery spasm as an under-recognized cause of MINOCA.
Disclosure
- Research title:
- Left anterior descending spasm caused a large anterior myocardial infarction
- Authors:
- Lior Shoev, Dan Haberman, Gera Gandelman, Jacob George, Natalia Kofman
- Institutions:
- Hebrew University of Jerusalem, Hebrew University of Jerusalem, Hebrew University of Jerusalem, Hebrew University of Jerusalem, Hebrew University of Jerusalem, Kaplan Medical Center, Kaplan Medical Center, Kaplan Medical Center, Kaplan Medical Center, Kaplan Medical Center
- Publication date:
- 2026-02-26
- OpenAlex record:
- View
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