COVADIS diagnostic criteria for vasospastic angina*

Vasospastic angina diagnostic criteria elements

1. Nitrate-responsive angina (during spontaneous episode, with at least one of the following):

Rest angina, especially between night and early morning
Marked diurnal variation in exercise tolerance, reduced in morning
Hyperventilation can precipitate an episode
Calcium channel blockers (but not beta blockers) suppress episodes

2. Transient ischemic ECG changes (during spontaneous episode, including any of the following in at least two contiguous leads):

ST-segment elevation ≥0.1 mV
ST-segment depression ≥0.1 mV
New negative U waves

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

ECG: Electrocardiogram.
* "Definitive vasospastic angina" is diagnosed if nitrate-responsive angina is evident during spontaneous episodes and either the transient ischemic ECG changes during the spontaneous episodes or coronary artery spasm criteria are fulfilled. "Suspected vasospastic 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.

Reproduced from: Beltrame JF, Crea F, Kaski JC, et al. International standardization of diagnostic criteria for vasospastic angina. Eur Heart J 2017; 38(33):2565-2568, by permission of Oxford University Press on behalf of the European Society of Cardiology. Copyright © 2015 Oxford University Press.

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COVADIS diagnostic criteria for vasospastic angina*