Observations on Coronary Spasm Complicating Non-Cardiac Surgery

For patients with pre-existing vasospastic angina, the risk of perioperative coronary artery spasm (PCAS) complicating non-cardiac surgery has not been quantified. Why PCAS occurs at all in patients without pre-existing vasospastic disease is unclear. The occurrence of PCAS was studied in 31 patients with a preoperative diagnosis of variant angina who underwent 54 non-cardiac surgical procedures. An extensive review of published literature was undertaken to summarize current knowledge of PCAS complicating non-cardiac surgery. In 31 patients with preoperative diagnosis of variant angina, in 54 non-cardiac surgeries, 9 morbid cardiac events occurred in 7 cases related to PCAS. In a larger group of patients with a diagnosis of variant angina, 7 were found who did not have a preoperative diagnosis of coronary disease, but who had their first episode of coronary spasm in the form of PCAS. In the medical literature describing cases of PCAS related to non-cardiac surgery, the incidence of PCAS in patients without preoperative coronary vasospasm was somewhere between 0.2 and 0.02 percent of cases undergoing non-cardiac surgery. In 40 of such cases, postoperative coronary angiography with provocative testing was positive for coronary spasm in 38 (95%). Thus, PCAS occurs rarely in the setting of non-cardiac surgery in cases without pre-existing coronary vasospasm. But it can cause potentially life threatening complications. In patients with pre-existing coronary vasospasm, PCAS is common and special preventive measures are justified to reduce the risk of its occurrence.