Long-term prognosis of patients with variant angina.

Abstract

The long-term prognosis of variant angina and the factors influencing it were assessed in 217 consecutive patients hospitalized in our coronary care unit and followed for a mean of 65 months (range 2 to 123). Cardiac death occurred in 30 patients and an additional 54 experienced a nonfatal myocardial infarction. Survival at 1 and 5 years was 95% and 89%, respectively; survival without infarction was 83% and 69%. Coronary disease and the degree of disease activity were strong predictors of survival by Cox analysis. Survival at 1 year was 99%, and that at 5 years was 95% and 94%, respectively, for patients with one-vessel disease (n = 81) and for those without stenoses of 70% or greater (n = 87). Survival at 1 and 5 years was only 87% and 77% for those with multivessel disease (n = 40 990-997, 1987. CORONARY ARTERY SPASM accounts for the clinical manifestations of variant angina but probably does not play a major role in most patients with other coronary syndromes. Therefore, the long-term outcome of patients with variant angina and the factors influencing their prognosis may differ from those for other patients with coronary disease.The follow-up of four large series of patients with variant angina has been reported. -4 In one of these studies we described 169 such patients followed for a mean of 15 months.2 Angina disappeared spontaneously in many patients after 1 year, particularly those with coexisting organic stenoses. The purpose of this report is to describe the prognosis, and the factors influencing prognosis, in a larger series of 217 patients followed prospectively for a mean of 65 months. MethodsPatients. The diagnosis of variant angina was made in patients meeting all the following criteria: (1) buming or squeezing retrosternal chest pain at rest, (2) relief of the pain by nitroglycerin in less than 5 min, (3) ST segment elevation of at least 2 mm not present on the baseline electrocardiogram but documented during pain and disappearing with relief of pain, and (4) no subsequent evidence of myocardial necrosis. Between April 1976 and April 1986, 217 patients meeting these criteria were hospitalized at the Montreal Heart Institute.The mean age of the patients was 51 years (range 24 to 71); 165 were men and 52 were women. ST segment elevation was noted at the anterior electrocardiographic leads in 112 patients and at the inferior leads in 105 patients. In 161 cases transient ST elevation was detected during resting angina and in the remaining 56 it was documented only after administration of ergonovine.Patient management. Patients were hospitalized in the coronary care unit, where they underwent continuous electrocardiographic monitoring for at least 3 days. A complete electrocardiogram was recorded during episodes of angina at rest when possible. Coronary arteriography was performed by a percutaneous transfemoral approach by use of preformed catheters with routine filming of sagitally angulated views of the left coronary artery. Patients were not routinely given nitroglycerin before angiog...

Long-term prognosis for patients with variant angina and influential factors.

“…Both survival and survival without myocardial infarction rates in our series were better than those reported previously by Severi et al, 16 Waters et al,17 Mark et 19 In these previous studies, the survival rate at 1 and 3 years ranged from 88% to 95% and from 84% to 92%, respectively, and the survival without myocardial infarction rate at 1 and 3 years ranged from 70% to 83% and from 63% to 77%, respectively. This difference is probably due to the fact that the percentage of patients with multivessel disease and/or impaired left ventricular function was smaller, and the percentage of patients who received a calcium antagonist (diltiazem or nifedipine) as the initial treatment was higher in our series.…”

Prinzmetal or Vasospastic Angina in a Young Woman: An Under-Diagnosed Pathology

“…Calcium channel blockers are the first-line drug therapy for vasospastic by their relaxing effect on arterial and antispastic smooth muscle cells. They improve survival [14] and their prescription is a recommendation, both European and Japanese, class I.…”

“…As instable angina, the prognosis of VSA is indeed related to the importance of the atheromatous lesions associated with, for Walling et al [14], a five-year survival of 95% of patients with one-vessel coronary artery disease and 77% of patients with multi-vessel coronary artery disease. This reinforces the value of the coronary angiographic evaluation of these patients during which a provocated spasm test could be performed.…”

Cardiac arrest related to coronary spasm in patients with variant angina: a three‐case study

“…Many studies show that patients with variant angina are at the highest risk of cardiac death or acute myocardial infarction during the early phase of the follow-up period, when disease activity is high [5,19,[30][31][32][33]. So during the first year of observation the patient must be followed very closely [19].…”