Long-term prognosis of medically treated patients with vasospastic angina and no fixed significant coronary atherosclerosis

Current clinical features, diagnostic assessment and prognostic determinants of patients with variant angina

“…Furthermore, in agreement with previous reports, a prevalent nocturnal angina was reported by about one half and effort-induced angina by about one third [9,11,13,15,18,19] of our patients.…”

“…Indeed, the clinical diagnosis required more than 3 months in > 40% of patients and >12 months in about 20%. This finding is in keeping with those of the earlier studies, which reported a time interval from symptom onset to diagnosis longer than 3 months in a proportion variable from 35% to 67% [9,11,13,14,19]. Thus our data suggest that the proportion of initial diagnostic mistakes in variant angina patients has remained substantially unchanged throughout the decades, questioning the quality of medical education about this clinical syndrome.…”

“…Overall, most of clinical events occurred in patients with normal coronary arteries or with 1-vessel coronary artery disease. These results are at variance with those of the earliest reports, which usually showed obstructive CAD and/or CAD severity as being among the most important predictors of death and, even more, of acute myocardial infarction [9,11,[13][14][15][16][17], but are in agreement with subsequent studies which reported relevant clinical events also in patients with normal or near normal coronary arteries at angiography [12,18,19].…”

Prognostic Value of I-123 Metaiodobenzylguanidine Imaging in Vasospastic Angina Without Significant Coronary Stenosis

“…[1][2][3][4] As a result, recently developed therapies, such calcium antagonists and other drugs, 21 and percutaneous coronary intervention for significant coronary stenosis or drug-resistant spasm, can overcome a poor prognosis for VA. Despite the elimination of these major predictors, there are still some high-risk VA patients who have cardiac events without significant coronary artery stenosis and as shown in the present study, these patients can be identified by MIBG imaging.…”

“…Of the patients admitted to the Shizuoka General Hospital for suspected ischemic heart disease between January, 1995 and November, 1999, 122 showed acetylcholineinduced coronary spasm in one of the 3 major arteries or major side branches during diagnostic coronary angiography, as well as the characteristic features of (1) sporadic typical chest pain often occurring at rest between midnight and early morning, (2) normal left ventricular function, and (3) no significant stenosis (<50%). Within 3 months of cardiac catheterization, the study patients underwent MIBG and then symptom-limited Tl-SPECT in the same week; 10 patients could not undergo both cardiac imagings were excluded from the study.…”