Clinical and Angiographic Characteristics and Long-term Follow-up in Patients with Variant Angina Who Presented as Acute Myocardial Infarction

Abstract

Background and Objectives There were numerous reports for clinical characteristics and prognosis of patients with variant angina VA but little information is available for patients with VA who presented as acute myocardial infarction AMI . The purpose of this study is to determine the clinical and angiographic predictors for initial development of AMI in patients with VA and prognosis of patients with VA who presented as AMI. Materials and Methods The study group comprised 166 patients with VA forty one 25% of whom presented as AMI Group A Male 32, mean age 50 years and 125 presented as typical VA or unstable angina Group B Male 73, mean age 54 years . The diagnosis of VA was made by spontaneous spasm and ergonovine or acetylcholine only Group B provocation. Results 1 Male gender 78% vs. 58%, p 0.05 , smoking 74% vs. 53%, p 0.05 , and disease duration 18 5 vs. 7 1 month, p 0.0001 , and ST-segment elevation during chest pain 71% vs. 23%, p 0.05 were significantly higher in group A than in Group B. 2 Prevalence of fixed stenosis of 50% or greater was higher in Group A than in group B 12% vs. 2%, p 0.05 and the percent stenosis after nitroglycerin injection was also greater in group A than in group B 43 5% vs. 28 2, p 0.01 , but the disease activity such as frequency of resting angina, spontaneous spasm, and multivessel spasm were not different between two groups. 3 During clinical follow-up at a mean duration of 2.7 years, three patient 2% in group B died of a cardiac cause. Non-fatal MI occurred 1 2% and 3 patients 2% in group A and B, respectively. Conclusions Our data show that male gender, smoking, duration of disease, ST-segment elevation during chest pain, and a fixed stenosis of 50% or greater are predictors for initial development of AMI in patients with VA. The prognosis in group A is excellent and this may be associated with less severe atherosclerotic disease and a high rate

Cardiogenic Shock From Global Myocardial Ischemia Induced by Simultaneous Multivessel Coronary Spasm

“…Serious cardiac conditions, such as myocardial infarction or malignant arrhythmias, may ensue in proportion to the extent and duration of ischemia. Prolonged coronary artery spasm as an underlying cause for acute myocardial infarction has been recognized 1 - 7) since the possibility was first suggested nearly 50 years ago. 8) However, global ischemia induced by simultaneous multiple coronary artery spasm, with clinical presentation of cardiogenic shock, has been rarely reported.…”