Coronary artery spasm in patients with normal or near normal coronary arteries: Long-term follow-up of 277 patients

Most studies on the natural course of coronary artery spasmin patients with normal or nearly normal coronary arteries arebased on medium-term follow-up in small populations. The presentseries includes 277 successive patients with a median follow-upof 89 months (range: 1 to 198 months). There were 206 men and71 women whose mean age was 53·6 ± 9·3years. They were all assessed with coronary arteriography whichrevealed no stenoses greater than 50%. Spasm was confirmed duringthe coronary arteriography in 157 patients (56·7%), bya positive provocation test following the arteriography in 113patients (40·8%), and by an electrocardiogram which showedPrinzmetal's variant angina in seven patients (25%). The majorityof patients, 264 (95·3%) were treated with calcium channelblockers. At the end of this study: 35 patients (12·6%) were lostto follow-up; 20 patients (7·2 died) including 10 (3·6%)from cardiac causes; 18 patients (6·5%) experienced myocardialinfarction in 11 of whom repeat coronary arteriography consistentlydemonstrated one or more significant stenoses (greater than70%); 109 patients (39%) had persistent angina, in 52 of whomthe severity (more than one episode per month) warranted repeatcoronary arteriography which detected significant stenosis in19 cases; 95 patients (34·3%) were asymptomatic. Multivariate statistical analyses showed that only predictorsof major coronary events (death, myocardial infarction or anginarequiring repeat coronary arteriography) were systemic hypertensionor the finding of minor parietal irregularities on the initialcoronary arterlogram. CONCLUSION: Despite treatment with calcium channel blockers, persistentor recurrent episodes of angina are frequently observed whereascomplications such as myocardial infarction or death are rare.