Eosinophilia and coronary artery vasospasm.
OBJECTIVE
To describe the clinical features, natural history and response to treatment of coronary vasospasm associated with eosinophilia.


METHODS
Two patients with eosinophilia who had recurrent acute coronary events due to multi-vessel coronary artery spasm are described. The clinical presentation and outcomes of these 2 patients and 17 additional cases of eosinophilia and coronary artery vasospasm identified on a systematic literature review are presented.


RESULTS
Patients were usually admitted because of repeated episodes of angina at rest and raised plasma markers of myocyte necrosis. Dynamic ST elevation was observed in 15 (83%) patients. Coronary angiography was performed in all patients. Spontaneous (n=7) or provoked (n=8) coronary artery spasm, which was usually multi-focal, was observed in 15 (83%) patients. Symptoms often continued despite high dose vasodilators but responded well to prednisone. Recurrent coronary events were frequent, and included sudden death (n=4), resuscitated cardiac arrest (n=2), myocardial infarction (n=10) and unstable angina (n=11). Recurrent events were more frequent when not taking compared to when taking prednisone (4.2 versus 0.4 events/year, p=0.002, hazard ratio 11, 95% confidence interval 2.4-50).


CONCLUSIONS
Published case reports suggest that coronary vasospasm associated with eosinophilia responds poorly to conventional vasodilator treatment and the risk of recurrent coronary events is high. Most patients respond to treatment which suppresses the eosinophilia.
Wong
Chi Wing
CW
Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
Luis
Sushil
S
Zeng
Irene
I
Stewart
Ralph A H
RA
D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects / Q000276:immunology; D001241:Aspirin / Q000009:adverse effects / Q000276:immunology; D003329:Coronary Vasospasm / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D004342:Drug Hypersensitivity / Q000150:complications*; D004802:Eosinophilia / Q000139:chemically induced / Q000150:complications*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin; D011241:Prednisone