Coronary Artery Vasospastic Disorders Summit diagnostic criteria for vasospastic anginaa

Vasospastic angina diagnostic criteria elements:

(1) 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 β-blockers) suppress episodes

(2) Transient ischaemic ECG charges — 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

(3) Coronary artery spasm — defined as transient total or subtotal coronary artery occlusion (>90% constriction) with angina and ischaemic ECG changes either spontaneously or in response to a provocative stimulus (typically acetylcholine ergot, or hyperventilation)

a ‘Definitive vasospastic angina’ is diagnosed if nitrate-responsive angina is evident during spontaneous episodes and either transient ischaemic ECG changes during the spontaneous episodes or coronary artery spasm criteria are fulfilled.
‘Suspected vasospasic angina’ is diagnosed if nitrate-responsive angina is evident during spontaneous episodes but transient ischaemic ECG changes are equivocal or unavailable and coronary artery spasm criteria are equivocal.


Microvascular Angina (MVA)* – Clinical Criteria

1. Symptoms of myocardial ischemia

a) Effort and/or rest angina
b) Angina equivalents (i.e. shortness of breath)

2. Absence of obstructive CAD (<50% diameter reduction or FFR by >0.80) by

a) Coronary CTA
b) Invasive coronary angiography

2. 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

3. Evidence of impaired coronary microvascular function

a) Impaired coronary flow reserve (cut-off values depending on methodology use between ≤2.0 and ≤2.5)
b) Abnormal coronary microvascular resistance indices (e.g. INR > 25)
c) Coronary microvascular spasm, defined as reproduction of symptoms, ischemic ECG shifts but no epicardial spasm during acetylcholine testing. d) Coronary slow flow phenomenon, defined as TIMI frame count >25.