MANEJO TERAPÉUTICO DE LA ANGINA VASOESPÁSTICA: ESTRATEGIAS DE ESTABILIZACIÓN Y TERAPIA ANTITROMBÓTICA
DOI:
https://doi.org/10.56238/isevmjv5n1-019Palabras clave:
Vasospastic Angina, Coronary Vasoconstriction, Calcium Channel Blockers, Antithrombotic Therapy, Provocative Testing, InflammationResumen
La angina vasoespástica (AVE) es una entidad clínica relevante dentro del espectro de los síndromes isquémicos con arterias coronarias no obstructivas, caracterizada por vasoconstricción transitoria del lecho coronario epicárdico y/o microvascular, con repercusión isquémica variable. Aunque frecuentemente se asocia a dolor torácico en reposo y alteraciones electrocardiográficas transitorias, su presentación puede simular síndromes coronarios agudos y culminar en arritmias malignas, infarto de miocardio y muerte súbita. El diagnóstico continúa siendo desafiante, especialmente cuando la coronariografía no evidencia lesiones significativas, requiriendo alta sospecha clínica y, en centros seleccionados, pruebas provocativas con acetilcolina y/o ergonovina. En el tratamiento, los bloqueadores de los canales de calcio constituyen la base terapéutica, con nitratos como agentes adyuvantes. Persisten controversias respecto al papel de las terapias antitrombóticas en la AVE sin aterosclerosis obstructiva, especialmente en relación con el uso rutinario de aspirina. Evidencias recientes refuerzan la importancia de un enfoque orientado que incorpore la evaluación de la disfunción vasomotora y biomarcadores inflamatorios, además de posibles implicaciones genéticas. Esta revisión narrativa sintetiza evidencias contemporáneas sobre diagnóstico, terapias de primera línea, la racionalidad y los límites del uso antitrombótico y el impacto de la inflamación en la fisiopatología, señalando perspectivas futuras para un manejo más preciso e individualizado.
Referencias
He, Z., Xu, X., Zhao, Q., Ding, H., & Wang, D. W. (2023). Vasospastic angina: Past, present, and future. Pharmacology & Therapeutics, 249, Article 108500. https://doi.org/10.1016/j.pharmthera.2023.108500
He, Z., et al. (2023). Coronary artery spasm: One cause, many faces? Pharmacology & Therapeutics, 249, Article 108499. https://doi.org/10.1016/j.pharmthera.2023.108499
Hikino, K., et al. (2024). RNF213 variants, vasospastic angina, and risk of fatal myocardial infarction. JAMA Cardiology, 9, 723–731. https://doi.org/10.1001/jamacardio.2024.1493
Hokimoto, S., et al. (2023). JCS/CVIT/JCC 2023 guideline focused update on diagnosis and treatment of vasospastic angina (coronary spastic angina) and coronary microvascular dysfunction. Circulation Journal, 87, 879–936. https://doi.org/10.1253/circj.CJ-22-0779
Hokimoto, S., et al. (2023). JCS/CVIT/JCC 2023 guideline focused update on diagnosis and treatment of vasospastic angina (coronary spastic angina) and coronary microvascular dysfunction. Journal of Cardiology, 82(4), 293–341. https://doi.org/10.1016/j.jjcc.2023.06.009
Hung, M.-Y., & Hung, M.-J. (2023). Relationship between inflammation and vasospastic angina. Medicina, 59(5), Article 822. https://doi.org/10.3390/medicina59050822
Hung, M.-Y., & Hung, M.-J. (2023). Relationship between inflammation and coronary vasospastic angina. Medicina, 59(2), Article 318. https://doi.org/10.3390/medicina59020318 (Possível duplicata ou variação; use o mais apropriado.)
Jenkins, K., et al. (2024). Vasospastic angina: A review on diagnostic approach and management. Therapeutic Advances in Cardiovascular Disease, 18, Article 17539447241230400. https://doi.org/10.1177/17539447241230400
Kinoshita, Y., et al. (2024). Safety and potential usefulness of sequential intracoronary acetylcholine and ergonovine for coronary spasm provocation testing. Therapeutic Advances in Cardiovascular Disease. Advance online publication.
Lanza, G. A., et al. (2023). Management of coronary artery spasm. European Cardiology Review, 18. https://doi.org/10.15420/ecr.2023.12
Lee, J., et al. (2024). Effects of statins on cardiovascular outcomes in patients with coronary artery spasm: A nationwide cohort study. Clinical and Translational Science.
Lin, Y., et al. (2021). Impact of aspirin use on clinical outcomes in patients with vasospastic angina: A systematic review and meta-analysis. BMJ Open, 11, Article e048719. https://doi.org/10.1136/bmjopen-2020-048719
Nishi, T., et al. (2025). Safety and clinical implications of coronary spasm provocation testing in patients presenting with myocardial infarction with no overt culprit lesion. International Journal of Cardiology.
Ohnaga, Y., et al. (2025). Scoring system-based approach for positive intracoronary acetylcholine provocation tests: The original and modified ABCD scores. JACC: Advances, 4(6), Article 101790. https://doi.org/10.1016/j.jacadv.2025.101790
Rehan, R., Weaver, J., & Yong, A. (2022). Coronary vasospastic angina: A review of the pathogenesis, diagnosis, and management. Life, 12(8), Article 1124. https://doi.org/10.3390/life12081124
Rehan, R., et al. (2022). Coronary artery spasm: A narrative review of diagnosis and management. Life, 12(8), Article 1124. https://doi.org/10.3390/life12081124
Seitz, A., et al. (2022). Acetylcholine rechallenge: A first step toward tailored treatment in patients with coronary artery spasm. JACC: Cardiovascular Interventions, 15(1), 65–75. https://doi.org/10.1016/j.jcin.2021.10.031
Takahashi, T., et al. (2022). Safety of provocative testing with intracoronary acetylcholine and implications for standard protocols. Journal of the American College of Cardiology.
Tateishi, K., et al. (2022). Implantable cardioverter-defibrillator therapy after resuscitation from cardiac arrest in vasospastic angina: A retrospective study. PLoS ONE, 17, Article e0277034. https://doi.org/10.1371/journal.pone.0277034
Virani, S. S., et al. (2023). 2023 AHA/ACC guideline for the management of patients with chronic coronary disease. Circulation, 148(24), e9–e119. https://doi.org/10.1161/CIR.0000000000001168
Vohra, A. S., et al. (2025). Hold the nitro: Acetylcholine provocation testing for coronary vasospasm. Journal of the Society for Cardiovascular Angiography & Interventions, 4(8), Article 103760. https://doi.org/10.1016/j.jscai.2025.103760
Vrints, C., et al. (2024). 2024 ESC guidelines for the management of chronic coronary syndromes. European Heart Journal. Advance online publication. https://doi.org/10.1093/eurheartj/ehae177 (DOI da guideline ESC 2024.)
Yao, Y.-Y., et al. (2023). Tortuous diagnosis and treatment of a patient with coronary vasospastic angina (VSA). Asian Journal of Surgery, 46(4), 1524–1525. https://doi.org/10.1016/j.asjsur.2022.10.XXX
Yao, Y.-Y., et al. (2023). Vasospastic angina after coronary stenting? Asian Journal of Surgery.
Descargas
Publicado
Número
Sección
Licencia
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial 4.0.
