Fig. 1

There were no significant obstructions in the right (a, c) or left (a’, c’) coronary artery, but intra-coronary ACh administration induced multivessel spasm (severe vasoconstriction in the distal right coronary artery [arrowheads in b]), and complete occlusion of the middle left anterior descending coronary artery [LAD, arrowhead in b’]). After the onset of acute coronary syndrome, an emergency coronary angiogram demonstrated no de novo lesions (Fig. 1d, d’)