Persistent coronary artery spasm documented by follow-up coronary angiography in patients with symptomatic remission of variant angina

Heart Vessels. 2013 May;28(3):301-7. doi: 10.1007/s00380-012-0249-2. Epub 2012 Apr 19.

Abstract

For patients with variant angina it is very important to start medical therapy using calcium-channel blockers. However, the decision of physicians regarding whether to decrease the dose of the drug or discontinue it is controversial. We investigated whether the nature of spasm is remissive and whether the termination of medications is safe. The subjects studied were included in the Vasospastic Angina in Catholic Medical Center Registry from March 2001 to December 2009. We analyzed 37 patients (62 lesions) with variant angina, diagnosed using coronary angiography (CAG) and he acetylcholine provocation test, without any organic coronary stenosis, whose symptoms were well controlled after medication. The follow-up CAG with provocation test was performed at a median interval of 44 months. The characteristics of spasm were analyzed on each pair of CAGs. The study group consisted of 23 men (62.2 %) and 14 women (37.8 %) with a mean age of 59 ± 11.1 years. The follow-up CAG with provocation test showed that the characteristics of the spasmodic nature were consistent with the first test in all patients. Although the patients with variant angina had no chest pain after medical treatment, the spasmodic nature of coronary arteries still remained. We may decrease the drug dosage after carefully checking the patient's symptoms but recommend not discontinuing therapy, even if the patient is asymptomatic.

MeSH terms

  • Acetylcholine
  • Aged
  • Angina Pectoris, Variant / diagnostic imaging*
  • Angina Pectoris, Variant / drug therapy
  • Calcium Channel Blockers / administration & dosage
  • Chi-Square Distribution
  • Coronary Angiography*
  • Coronary Vasospasm / diagnostic imaging*
  • Coronary Vasospasm / drug therapy
  • Coronary Vessels / diagnostic imaging*
  • Coronary Vessels / drug effects
  • Drug Administration Schedule
  • Female
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prospective Studies
  • Registries
  • Remission Induction
  • Republic of Korea
  • Time Factors
  • Treatment Outcome
  • Vasoconstrictor Agents
  • Vasodilator Agents / administration & dosage

Substances

  • Calcium Channel Blockers
  • Vasoconstrictor Agents
  • Vasodilator Agents
  • Acetylcholine