{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T18:01:28Z","timestamp":1785175288910,"version":"3.55.0"},"reference-count":21,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Cardiology"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Coronary vasomotor disorders are frequently underdiagnosed in women with angina and non\u2010obstructive coronary arteries. We investigated clinical presentation, diagnostic delay, spasm subtype, and patient\u2010reported treatment response in women with acetylcholine\u2010confirmed coronary spasm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This single\u2010center observational study included women with a positive intracoronary acetylcholine provocation test who completed a locally developed questionnaire on symptoms, triggers, comorbidities, medication tolerance, and treatment response. Epicardial spasm was defined as \u2265\u200990% epicardial diameter reduction with symptom reproduction and ischemic ECG changes; microvascular spasm as symptoms and ischemic ECG changes with &lt;\u200990% epicardial vasoconstriction. Diltiazem was initiated as first\u2010line therapy, with amlodipine as an alternative. Regression analyses exploring therapeutic failure were considered exploratory because of the low event count.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>A total of 194 women were included (median age 60 years [IQR 52\u201367]). Chest pain\/tightness was reported by 163\/190 (85.8%), dyspnea by 70\/135 (51.9%), and palpitations by 74\/136 (54.1%). Epicardial\/microvascular spasm was present in 110\/187 (58.8%) and 77\/187 (41.2%). Median symptom\u2010to\u2010diagnosis time was 24 months [IQR 8\u201390]. Diltiazem was prescribed in 162\/194 (83.5%). Among respondents with follow\u2010up data, symptom frequency decreased in 103\/128 (80.5%), episode duration decreased in 91\/118 (77.1%), and pain intensity decreased\/resolved in 92\/115 (80.0%). Therapeutic failure occurred in 8\/106 (7.5%). Residual symptom burden remained common, with CCS class &gt; II at follow\u2010up in 65\/124 (52.4%) and persistent complaints in 53\/107 (49.5%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In women with acetylcholine\u2010confirmed coronary spasm, symptom burden and diagnostic delay were substantial. Calcium\u2010channel blocker therapy was associated with patient\u2010reported symptom improvement among respondents with available follow\u2010up data.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/clc.70424","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T10:45:48Z","timestamp":1784630748000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical Presentation and Treatment Response in Women With Acetylcholine\u2010Confirmed Coronary Spasm: A Single\u2010Center Observational Study"],"prefix":"10.1002","volume":"49","author":[{"given":"Josephine","family":"Sikulu","sequence":"first","affiliation":[{"name":"Department of Cardiology Luisenhospital Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralf","family":"Kubini","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rhein\u2010Maas Hospital, Nephrology and Internal Intensive Care W\u00fcrselen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muath","family":"Turkman","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rhein\u2010Maas Hospital, Nephrology and Internal Intensive Care W\u00fcrselen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moritz Benjamin","family":"Immohr","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Center, University Hospital Essen University of Duisburg\u2010Essen Essen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Becker","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rhein\u2010Maas Hospital, Nephrology and Internal Intensive Care W\u00fcrselen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2243-8743","authenticated-orcid":false,"given":"Rashad","family":"Zayat","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery RWTH University Hospital Aachen Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0871-9573","authenticated-orcid":false,"given":"Ali","family":"Aljalloud","sequence":"additional","affiliation":[{"name":"Department of Cardiology Rhein\u2010Maas Hospital, Nephrology and Internal Intensive Care W\u00fcrselen Germany"},{"name":"Department of Cardiac Surgery RWTH University Hospital Aachen Aachen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1067\/mhj.2001.114198"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehaa503"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2011.11.015"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2021.02.079"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00380-014-0614-4"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/5289776"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13293-020-00341-4"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.124.037942"},{"key":"e_1_2_13_10_1","first-page":"2565","article-title":"International Standardization of Diagnostic Criteria for Vasospastic Angina","volume":"38","author":"Beltrame J. 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