Clinical Syndrome of Variant Angina with Normal Coronary Arteriogram

Selzer, Arthur; Langston, Manly F.; Ruggeroli, Charles W.; Cohn, Keith

doi:10.1056/nejm197612092952403

Cited by 155 publications

(29 citation statements)

References 30 publications

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“…According to the reports by Nakagawa et al (2) The methacholine-induced ECG changes in the intact rat resemble those seen during variant anginal attacks caused by severe vasospasm of a large coronary artery in patients (8)(9)(10)(11).…”

Section: Discussionmentioning

confidence: 99%

Effects of N-(2-hydroxyethyl)nicotinamide nitrate (SG-75) on methacholine-induced ecg changes in intact anesthetized rats.

1981

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Section: Discussionmentioning

confidence: 99%

Effects of N-(2-hydroxyethyl)nicotinamide nitrate (SG-75) on methacholine-induced ecg changes in intact anesthetized rats.

1981

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“…18,21,22 Women are also more likely to have unusual pathophysiological mechanisms of CAD such as spontaneous coronary artery dissection (SCAD) or coronary artery spasm (CAS). [23][24][25][26] Compared with men, women with ACS and those after coronary revascularization have longer hospitalizations and higher in-hospital mortality, manifest more bleeding complications, and endure …”

Section: Prevalence Of Amimentioning

confidence: 99%

Acute Myocardial Infarction in Women

Mehta¹,

Beckie²,

DeVon³

et al. 2016

Circulation

910

393

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Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men; however, over the last decade, there have been marked reductions in cardiovascular disease mortality in women. The dramatic decline in mortality rates for women is attributed partly to an increase in awareness, a greater focus on women and cardiovascular disease risk, and the increased application of evidence-based treatments for established coronary heart disease. This is the first scientific statement from the American Heart Association on acute myocardial infarction in women. Sex-specific differences exist in the presentation, pathophysiological mechanisms, and outcomes in patients with acute myocardial infarction. This statement provides a comprehensive review of the current evidence of the clinical presentation, pathophysiology, treatment, and outcomes of women with acute myocardial infarction.

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“…attacks decrease in number or disappear entirely during treatment in most patients who develop these complications. 38 In the study of Severi et al ,2 nearly all patients were treated with verapamil; their good long-term prognosis despite a high prevalence of organic coronary disease contrasts with the poor prognosis noted in reports5' [7][8][9] in which calcium antagonists were not used. One possible explanation for this difference is that calcium antagonists reduce the incidence of myocardial infarction and death.…”

mentioning

confidence: 96%

Factors influencing the long-term prognosis of treated patients with variant angina.

Waters¹,

Miller²,

Szlachcic³

et al. 1983

Circulation

143

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To determine the prognosis of variant angina and the factors influencing it, 169 consecutive patients hospitalized in our coronary unit were followed for a mean of 15.3 months (range 1 to 68). Survival at 1, 2, and 3 years was 95%, 90%, and 87%, respectively; survival without myocardial infarction was 80%, 78%, and 75%. Twenty of the 22 myocardial infarctions and eight of the 14 deaths occurred within the first 3 months. Mantel-Haenszel log-rank analysis demonstrated that coronary disease, ventricular function, and the degree of disease activity were significant interdependent variables that influenced both survival and survival without infarction. At 1, 2, and 3 years, survival for patients with multivessel disease was 81%, 76%, and 66%; for patients with one-vessel disease, 97%, 92%, and 92%; and for patients without stenoses ¢ 70%, 98% at each year (p = .0003). Survival without infarction at 1 year was 88% in patients with no stenoses > 70% and 82% in patients with single-vessel disease; it did not change thereafter in either group, but was 62%, 58%, and 50% at 1, 2, and 3 years in patients with multivessel disease (p = .001). Treatment did not influence survival in any subgroup (only 14 patients died overall) or survival without infarction in patients with multivessel disease. However, in patients without multivessel disease, treatment with nifedipine, diltiazem, and verapamil improved survival without infarction compared to treatment with perhexiline maleate or long-acting nitrates alone (92% vs 67% at 1, 2, and 3 years; p < .005). Thus in addition to preventing angina, nifedipine, diltiazem, and verapamil appear to reduce complications in patients with variant angina without multivessel disease. Circulation 68, No. 2, 258-265, 1983. PROGNOSIS has been well defined in most subgroups of patients with coronary artery disease. However, the natural history of variant angina is unclear because the syndrome is characterized by frequent spontaneous exacerbations and remissions and because, except for the series described by Maseri et al. ' and Severi et al.,2 most reports involve small numbers of patients, heterogenous treatment, or different selection criteria.3 [1][2][3][4] During a recent 5 year period, 169 patients with variant angina were hospitalized at our institution. All but seven underwent coronary arteriography and all survivors were seen at regular intervals after discharge at our variant angina clinic. The purpose of this article

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Clinical Syndrome of Variant Angina with Normal Coronary Arteriogram

Cited by 155 publications

References 30 publications

Effects of N-(2-hydroxyethyl)nicotinamide nitrate (SG-75) on methacholine-induced ecg changes in intact anesthetized rats.

Effects of N-(2-hydroxyethyl)nicotinamide nitrate (SG-75) on methacholine-induced ecg changes in intact anesthetized rats.

Acute Myocardial Infarction in Women

Factors influencing the long-term prognosis of treated patients with variant angina.

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