Correspondence Letter by Alvarez Regarding Article, “Coronary Artery Spasm: A 2009 Update” To the Editor:

coronary artery spasm published on May 12, 2009.1 Their article starts with a case presentation: “A 37-year-old man was admitted in the early morning hours to the emergency department after experi-encing excruciating chest pain. The patient was a heavy smoker who gave a history of several previous similar. ECG showed a 2 to 3 mm ST elevation which returned to baseline quickly, concomitant with his pain subsiding. Twenty-four hours later, a treadmill test showed good exercise capacity and no ST changes even at target heart rate.” The authors present this case as an example of coronary artery spasm, but, in my opinion, an alternative diagnosis should be considered that would importantly alter management. When evalu-ating a male patient with a history of heavy smoking who presents with chest pain and ST-segment elevation, I would be most con-cerned about plaque rupture, even if the ST segment returns to baseline. Coronary artery spasm does not have pathognomoni