64层CTA结合血清MMP-9、sCD40L评价冠脉临界病变斑块成分及稳定性

目的:通过64层计算机体层摄影冠状动脉血管造影识别冠状动脉临界病变患者的冠脉斑块成分,并检测血清基质金属蛋白酶-9（MMP-9）、可溶性CD40配体（sCD40L）水平,探讨其斑块稳定性及临床意义。方法: 选择经64层计算机体层摄影冠状动脉血管造影证实至少有1支冠脉某一阶段狭窄30%～70%的患者65例,其中稳定型心绞痛36例,不稳定型心绞痛29例,通过斑块CT值及冠脉管腔碘造影剂CT值确定其斑块类型:非钙化斑块,钙化斑块和混合斑块;并用ELISA方法测定患者及37例无心血管疾病对照组血清MMP-9、sCD40L水平,比较其差异性并探讨其相互关系。结果: 冠脉临界病变患者混合斑块最多,其次为非钙化斑块,钙化斑块最少,“混合斑块+非钙化斑块”显著多于钙化斑块数目;患者血清MMP-9、sCD40L水平显著高于无心血管疾病对照组。结论: 冠心病冠脉临界病变斑块多为易损斑块。     

冠状动脉轻中度狭窄病变合并痉挛的介入治疗12例分析

目的:观察冠状动脉内支架对物治疗效果不佳的变异型心绞痛患者的临床效果.方法:35例明确诊断为变异型心绞痛患者,均口服钙离子拮抗剂,硝酸脂类调脂类药物,并行冠状动脉造影术及血管内超声(IVUS).其中12例药物治疗效果不佳的患者行冠状动脉内支架术.术后随访1～3年,6～9个月时复查冠状动脉造影.结果:冠状动脉造影显示35例患者中3例未见明显狭窄,32例有32%～75%的固定狭窄.12例物治疗效果不佳的患者根据发病时心电图,结合冠状动脉造影及IVUS判断9例痉挛在右冠状动脉,痉挛部位2例在近段,5例在中段,1例在远段,近段合并远段1例,固定狭窄40%～75%;3例痉挛在左前降支,痉挛部位在近段,2例在中段,固定狭窄50%～75%.犯罪病变多为边缘不光滑,呈偏心稳定的纤维性斑块,伴血管正性重构.12例患者相应冠状动脉成功置入(3.0～405)mm×(16～36)mm药物涂层支架,完全覆盖病变.术后随访1～3年,1例患者仍有胸痛发作;2例患者偶有胸痛,但程度及持续时间较术前明显减轻;9例患者无明显症状.6～9个月时复查冠状动脉造影显示11例患者支架段有轻度内膜增生,未见再狭窄;1例患者支架内50%～60%再狭窄,但仅偶有胸痛症状;其他部位无明显变化.结论:正规合理的物治疗对多数变异型心绞痛患者有效,但对少数药物治疗效果不佳的变异型心绞痛患者,可考虑行冠状动脉内支架术,近期效果良好.     

64层螺旋CT评价冠状动脉斑块稳定性的临床价值

目的研究64层螺旋CT在冠状动脉斑块稳定性的诊断价值。方法选择2010年3月~2012年2月来我院接受治疗的78例冠心病患者作为研究对象,其中38例ACS患者当做观察组,40例SA患者当做对照组,对比两组患者斑块的形态和数量和CT值的变化情况。结果在78例患者中总共检测到的斑块有163个,其中在38例急性冠状动脉综合症患者中检测到77个斑块,在40例稳定性心绞痛患者中检查到86个斑块。对照组的Ⅱ型和Ⅲ型斑块比率明显低于观察组。在163块斑块中,急性冠状动脉综合症患者总共有77块斑块,有44个斑块的冠状动脉重构指数大于等于1,正向重构率为57.1%。稳定性心绞痛总共86块,有21个斑块的冠状动脉重构指数大于等于1,正向重构率为24.4%。急性冠状动脉综合症患者有38致病斑块,其CT值约为(29±23)HU,稳定性心绞痛患者有40致病斑块,其CT值约为(68±29)HU。在38例急性冠状动脉综合征患者中,有20例患者有粥样斑块出现在非致病节段中,这些患者的致病节段的CT值约为(23±24)HU,非致病节段的CT值约为(51±27)HU。结论 64层螺旋CT能够有效鉴别斑块的稳定性,值得在临床上推广应用。     

孤立性左冠状动脉主干狭窄17例临床分析

目的 :探讨孤立性左冠状动脉主干 (左主干 )狭窄的临床特点、造影所见及治疗方法。　　方法 :1确立左主干狭窄≥ 5 0 % ,而其它三大主要冠状动脉支及其分支均无明显狭窄为孤立性左主干狭窄。 2冠状动脉造影常规采用 Judkin's法完成 ,于右前斜位 30°投照行左心室造影 ,观察左心室壁运动并计算左心室射血分数(L VEF)。　　结果 :1冠状动脉造影 4942例中检出孤立性左主干狭窄 17例 ,占 0 .34 %。 2 16例 (94.1% )表现为劳力型或恶化劳力型心绞痛 ,10例 (5 8.8% )于心绞痛发作时心电图 V3～ 5 导联 ST段下移 0 .2～ 0 .4m V,3例 (17.6 % )有心肌梗塞史。 3左心室造影 5例 (2 9.4% )有轻度节段性心室壁运动障碍 ,平均 L VEF 0 .6 9± 0 .0 8。 4左主干狭窄部位 :开口部 9例 (5 2 .9% ) ,中段 3例 (17.6 % ) ,分叉前 5例 (2 9.4% )。5 12例 (70 .6 % )行冠状动脉旁路移植术 (CABG) ,术后 11例 (91.7% )心绞痛消失。 2例行经皮冠状动脉腔内成形术 (PTCA)及支架植入术 (ICS) ,取得良好效果。 2例内科保守治疗 ,1例造影后死亡。　　结论 :临床上孤立性左主干狭窄非常少见 ,大多数患者心绞痛症状严重 ,病因以动脉粥样硬化最常见。治疗以冠状动脉旁路移植术效果最佳。     

合并危及生命的心律失常的变异型心绞痛患者临床特点

目的:探讨合并危及生命的心律失常的变异型心绞痛患者的临床特点并分析其预后,为该病的防治提供依据.方法:回顾性研究14例合并危及生命的心律失常的变异型心绞痛患者的临床特征,并随访其心脏事件.结果:变异型心绞痛合并危及生命的心律失常发生率为8.14%;诱发因素多为吸烟(92.86%)、ST段抬高的导联显示下壁缺血(92.86%);以心动过缓为主;3例患者出现2支冠状动脉先后发生痉挛(21.43%);冠状动脉造影检查示4例患者冠状动脉狭窄>50%,其中3例患者因痉挛相关的冠状动脉狭窄>80%并行介入治疗;随访的11例患者中1例猝死,1例出现2次心绞痛发作伴Ⅲ度房室传导阻滞.结论:冠状动脉痉挛所致的变异型心绞痛患者会发生危及生命的心律失常,且以高度房室传导阻滞为主.     

急性冠状动脉综合征患者冠状动脉循环中基质金属蛋白酶-9和白细胞介素-18变化及其意义

目的 :探讨急性冠状动脉综合征患者冠状动脉循环中基质金属蛋白酶 9(MMP 9)和白细胞介素 18(IL 18)水平变化及其意义。　　方法 :酶联免疫吸附测定法测定 2 8例急性冠状动脉综合征患者 (急性冠状动脉综合征组 )、 2 4例稳定性心绞痛患者 (稳定性心绞痛组 )及 2 0例胸闷、胸痛等症状予以冠状动脉造影正常患者 (对照组 )冠状动脉开口与冠状静脉窦口MMP 9和IL 18水平 ,并分析冠状动脉病变情况。　　结果 :①急性冠状动脉综合征组冠状动脉开口、冠状静脉窦口血浆MMP 9水平以及冠状静脉窦口与冠状动脉开口的差值分别与对照组和稳定性心绞痛组比较 ,均有显著性差异 (P <0 0 1)。②急性冠状动脉综合征组冠状动脉开口和冠状静脉窦口血浆IL 18水平明显高于对照组和稳定性心绞痛组 ,均有显著性差异 (P <0 0 1) ,但 3组之间冠状静脉窦口与冠状动脉开口IL 18的差值无显著性差异 (P >0 0 5 )。③急性冠状动脉综合征组和稳定性心绞痛组冠状动脉狭窄程度与MMP 9和IL 18水平均无明显相关 (P >0 0 5 )。④急性冠状动脉综合征组血浆MMP 9与IL 18水平冠状动脉开口处呈显著性正相关 (r =0 5 3 7,P <0 0 1)。　　结论 :急性冠状动脉综合征患者血浆MMP 9主要来源于冠状动脉循环 ,同时血浆IL 18水平亦明显升高 ,均与冠     

冠状动脉心肌桥的临床意义

目的:探讨冠状动脉心肌桥的临床意义。方法:回顾分析接受选择性冠状动脉造影的756例病人中检出的82例(10.8%)有心肌桥患者的资料。结果:82例心肌桥患者临床表现为稳定型心绞痛者10例(12.2%),不稳定型心绞痛者33例(40.2%),不明原因的胸痛者34例(41.5%),急性心肌梗塞者3例(3.7%),肥厚型心肌病者2例(2.4%);心肌桥近端存在冠状动脉狭窄者23例(28.0%),心肌桥远端存在冠状动脉狭窄者3例(3.7%),孤立性心肌桥(无冠脉狭窄)者46例(56.1%)。结论:心肌桥的发生率高,可导致心肌缺血,引起心绞痛;对临床疑诊心绞痛的病人应尽早常规行冠状动脉造影检查。     

炎性因子与急性冠状动脉综合征及颈动脉复杂斑块相关

目的研究急性冠状动脉综合征与颈动脉易损斑块之间是否相关。方法92例急性冠状动脉综合征患者和97例稳定型心绞痛患者均接受冠状动脉造影检查,40例正常者为对照。采用高分辨率超声测定患者颈动脉内膜中膜厚度、双侧颈动脉粥样斑块数和斑块的特征,采用酶联免疫吸附法测定血浆基质金属蛋白酶9、细胞间粘附分子1和高敏C反应蛋白的浓度。结果急性冠状动脉综合征患者基质金属蛋白酶9、细胞间粘附分子1和高敏C反应蛋白均显著高于稳定型心绞痛和正常对照者,具有颈动脉复杂斑块的急性冠状动脉综合征患者显著高于稳定型心绞痛与正常对照者,Logistic多元回归分析发现,高敏C反应蛋白>4.0mg/L(OR为5.37,95%CI为1.43~15.21,P=0.003)、基质金属蛋白酶9>300μg/L(OR为3.12,95%可信限为1.11~8.98,P=0.027)、细胞间粘附分子1>200μg/L(OR为4.78,95%可信限为1.34~9.89,P=0.010)、体质指数>24(OR为1.78,95%可信限为1.12~2.67,P=0.04)、急性心肌梗死(OR为3.37,95%可信限为1.66~8.91,P=0.008)、不稳定型心绞痛(OR为3.31,95%可信限为1.22~9.88,P=0.011)均与颈动脉复杂斑块相关。结论急性冠状动脉综合征患者颈动脉易损斑块数目显著高于稳定型心绞痛患者和正常对照者,急性冠状动脉综合征与颈动脉易损斑块有相关关系。     

冠状动脉内乙酰胆碱激发试验与麦角新碱激发试验的对比研究

目的 :比较选择性冠状动脉内乙酰胆碱 (Ach)和麦角新碱 (ER)激发试验对冠状动脉痉挛性心绞痛诊断的敏感性、特异性和安全性。　　方法 :79例患者中对 41例患者实施了Ach激发试验 ,根据冠状动脉造影及有无心绞痛和ST段改变分为AchⅠ组和AchⅡ组 ,注药剂量右冠状动脉依次为Ach 2 0 μg和 50 μg ,左冠状动脉依次为 2 0 μg、 50 μg和 10 0 μg ;另 3 8例患者实施了ER激发试验 ,根据冠状动脉造影及有无心绞痛和ST段改变分为ERⅠ组和ERⅡ组 ,右冠状动脉注入ER 2 0 μg ,左冠状动脉注入 3 2 μg。以注入Ach或ER后冠状动脉出现完全或接近完全闭塞 (≥ 99%狭窄 )为激发试验阳性。　　结果 :Ach法诊断冠状动脉痉挛性心绞痛的敏感性为 90 % ,ER法的敏感性为 72 % ,二者差异无显著性 (P >0 0 5) ,二者的特异性均为 10 0 %。影响血流动力学的并发症Ach法 9 8% (4/ 41) ,ER法 2 8 9% (11/ 3 8) ,二者差异性显著 (P <0 0 5)。激发多支血管痉挛阳性率AchⅠ组 15 0 % (3 / 2 0 ) ,ERⅠ组 5 6% (1/ 18) ,二者差异无显著性 (P >0 0 5)。　　结论 :两种方法诊断冠状动脉痉挛性心绞痛均有较高的敏感性、特异性和安全性 ,Ach法更为安全 ,并且有利于多支血管痉挛的研究     

冠心病患者血浆RANTES及MMP-9水平及与冠状动脉狭窄的相关性研究

目的 探讨冠心病患者血浆调节正常T细胞表达和分泌的细胞因子(RANTES)及基质金属蛋白酶-9(MMP-9)的水平及与冠状动脉狭窄的相关性.方法 选取住院的冠心病患者64例,其中不稳定性心绞痛患者26例(UA组)及急性心肌梗死患者16例(AMI组),稳定性心绞痛患者22例(SA组),同期冠状动脉造影正常的20例患者作为...     

血清脂蛋白（a）水平与冠状动脉狭窄及心绞痛类型的关系

目的 :探讨血清脂蛋白 （ a） [L p（ a） ]与冠状动脉狭窄程度及心绞痛类型的关系。方法 :将 91例冠脉造影患者按狭窄程度分组 ,比较各组血清 L p（ a） ,C反应蛋白及血脂指标等 ,并对其中 76例按心绞痛分 2组 ,也进行同样的比较 ,均进行统计学分析。结果 :血清 L p（ a）水平在冠脉明显狭窄以及多支血管病变患者显著升高 ,不稳定心绞痛患者的血清 L p（ a）水平也明显高于稳定型心绞痛患者 （ P<0 .0 1） ,L p（ a）异常率在冠脉造影阴性与冠脉造影阳性患者中有明显差异 ,不稳定型心绞痛患者的 L p（ a）异常率所占比例较稳定型患者高 （ 77% vs5 1% ,P<0 .0 1）。结论 :L p（ a）水平与冠脉狭窄程度和心绞痛类型明确相关     

Clinical, haemodynamic, and coronary angiographic correlates of angina pectoris in patients with severe aortic valve disease.

Of 88 consecutive patients aged 20 to 77 years with severe symptomatic aortic valve disease requiring surgery, 51 patients had angina pectoris; of these 51, 41 had predominant aortic stenosis and 10 had severe aortic regurgitation. All patients with angina pectoris underwent coronary angiography; significant coronary arterial disease was encounted in 24 per cent of those with aortic stenosis and 20 per cent of those with aortic regurgitation. By contrast, of 37 patients without angina pectoris 19 underwent coronary arteriography; none showed significant coronary artery disease (P smaller than 0.05). Among patients with angina pectoris, 17 per cent of those with aortic stenosis experienced prolonged, rest or nocturnal pain, compared to 70 per cent of those with aortic regurgitation (P smaller than 0.005). At the time of onset of angina pectoris, there were features of heart failure in 34 per cent of those with aortic stenosis, and in 90 per cent of those with aortic regurgitation (P smaller than 0.005). Nitroglycerin promptly relieved angina pectoris in 56 percent of patients with aortic stenosis and in 50 per cent of those with aortic regurgitation (P smaller than 0.05). Neither the pattern of angina pectoris nor the response to nitroglycerin was dependent upon the coexistence of significant coronary artery disease. In patients with aortic stenosis, there was not significant difference between those with angina pectoris, and those without angina with regard to left ventricular end-diastolic volume, end-diastolic pressure, ejection fraction, peak systolic pressure, wall thickness, cardiac index, or the product of these factors. In patients with aortic regurgitation, cardiac index was significantly lower (P smaller than 0.05), left ventricular end-diastolic volume tended to be larger, and ejection fraction tended to be lower in patients with angina pectoris as opposed to those without angina pectoris.     

Myocardial oxygen supply/demand ratio in aortic stenosis: hemodynamic and echocardiographic evaluation of patients with and without angina pectoris

Angina pectoris is a common symptom in patients with aortic stenosis without coronary artery disease. To investigate the correlates of angina pectoris, echocardiographic and hemodynamic data from 44 patients with aortic stenosis and no coronary artery disease (mean age 56 +/- 10 years) were analyzed. Twenty-three patients had no angina pectoris and 21 patients had angina pectoris. The ratio of the diastolic pressure-time index (area between the aortic and left ventricular pressure curves during diastole) to the systolic pressure-time index (area under the left ventricular pressure curve during systole), an index of the oxygen supply/demand ratio, was not different in patients with or without angina pectoris. There were no differences between patients with and without angina pectoris in echocardiographically determined wall thickness, chamber size, systolic and diastolic wall stress and left ventricular mass; in electrocardiographically defined voltage; and in hemodynamically defined aortic valve area, transaortic gradient and stroke work index. Thus, echocardiographic and hemodynamic measurements at rest are not significantly different in the presence or absence of angina pectoris in patients with aortic stenosis. Dynamic data appear to be essential for evaluation of the mechanisms of angina pectoris in patients with aortic stenosis.     

Increased incidence of coronary artery disease and cardiac death in elderly diabetic nephropathy patients undergoing chronic hemodialysis therapy

OBJECTIVES: The incidence of coronary artery disease and cardiac death was investigated in elderly diabetic patients undergoing chronic hemodialysis therapy. METHODS: Three hundred thirty-five patients who began hemodialysis therapy since 1992 were followed up by echocardiography and treadmill exercise testing. Coronary angiography was also performed in patients with angina pectoris. Angina pectoris was defined as clinical symptoms > Canadian Cardiovascular Society classification II, and asynergy findings by echocardiography or ST depression > 0.1 mV during the treadmill exercise test. Coronary artery stenosis was defined as narrowing > or = 75%. Patients were divided into 4 groups: diabetic nephropathy (DN) > or = 65 years old (Group O/DN, n = 56), DN < 65 years old (Group Y/DN, n = 84), non-DN > or = 65 years old (Group O/non-DN, n = 76) and non-DN < 65 years old (Group Y/non-DN, n = 119). RESULTS: Between 1992 and 1998, there were 137 patients with angina pectoris (40.9%), 79 with coronary artery stenosis (23.6%) and 37 with cardiac death (11.0%). Cumulative incidences of angina pectoris, coronary artery stenosis and cardiac death were significantly higher in the following order of groups; O/DN > Y/DN > O/non-DN > Y/non-DN. Five-year cumulative incidences of angina pectoris, coronary artery stenosis and cardiac death in Groups O/DN vs Y/non-DN were 72.2% vs 38.6%, 53.7% vs 12.2% and 50.6% vs 3.5%, respectively. Relative risks of aging and diabetic nephropathy for angina pectoris, coronary artery stenosis and cardiac death were 3.8, 7.9 and 22.4, respectively (p < 0.0001). CONCLUSIONS: Aging and the presence of diabetes are strong risk factors for coronary artery disease and cardiac death in hemodialysis patients. Therefore, diagnosis and treatment of coronary artery disease should be achieved at the early stage of hemodialysis therapy.     

联合检测氨基末端脑钠肽前体和高敏C反应蛋白与冠脉病变程度的相关性研究

目的探讨急性冠脉综合征(ACS)患者冠状动脉粥样硬化程度和血浆氨基末端脑钠肽前体、高敏C反应蛋白水平之间的相关性。方法 ACS患者120例均行冠状动脉造影术,分为不稳定型心绞痛组(UAP组)40例,急性非ST段抬高性心肌梗死组(NSTEMI组)40例与急性ST段抬高性心肌梗死组(STEMI组)40例;同期正常体检者40名作为对照组。冠状动脉病变严重程度用病变血管支数及Gensini评分表示,于入院第2天抽血检测血浆氨基末端脑钠肽前体和高敏C反应蛋白水平,并进行比较。结果 ACS各组血浆氨基末端脑钠肽前体、高敏C反应蛋白水平和Gensini评分显著高于对照组(P<0.01),ACS各组氨基末端脑钠肽前体水平比较差异有统计学意义(P<0.05),Gensini评分各组比较差异无统计学意义;STEMI组高敏C反应蛋白水平高于NSTEMI组和UAP组(P<0.01);NSTEMI组与UAP组高敏C反应蛋白水平比较差异无统计学意义。血浆氨基末端脑钠肽前体、高敏C反应蛋白水平和Gensini评分随病变支数的增加而增加。结论联合检测氨基末端脑钠肽前体和高敏C反应蛋白水平可判断ACS的严重程度,对其诊治及指导早期行有创检查均有重要参考价值。     

血清血管内皮生长因子的检测对急性冠脉综合征的临床意义

目的:探讨血清血管内皮生长因子(VEGF)水平对急性冠脉综合征病情判断的临床意义。方法:采用双抗体夹心EL ISA法测定74例冠状动脉造影证实有至少1支以上冠状动脉狭窄≥50%的冠心病患者的血清VEGF水平。结果:血清VEGF水平在急性冠状动脉综合征患者中明显升高,与正常组和稳定型心绞痛组间有非常显著性差异(P<0.01);而稳定型心绞痛组显著高于正常对照组(P<0.05);双支和三支血管病变患者血清VEGF水平高于单支病变组。结论:冠心病患者血清VEGF水平升高,其升高程度与冠状动脉病变程度、病变活动度有关。     

不稳定性心绞痛冠状动脉造影和血运重建的可行性探讨

目的研究不稳定性心绞痛的临床及介入心脏病学诊疗,并探讨其诊疗指引。方法分析包括初发型、恶化型、卧位型、变异型、中间综合征共63例不稳定性心绞痛患者的临床介入心脏病学诊疗资料,患者均行选择性冠状动脉造影。结果37例患者冠状动脉造影显示冠脉狭窄,占58.7％,其中70.3％狭窄程度大于50％,43.8％为多支冠脉狭窄。年龄、性别、病程、血脂在冠脉狭窄与非狭窄患者之间的差别无统计意义,但伴高血糖或高血压的患者冠脉狭窄发生率明显高于不伴高血糖或高血压患者。另冠脉狭窄中67.5％患者24小时动态心电图示ST下移≥0.2mV。26例冠脉狭窄大于50％的患者作了介入治疗后心绞痛消失。结论不稳定性心绞痛尤其伴高血压、高血糖或24小时动态心电图ST下移≥0.2mV患者多数有冠脉器质性狭窄,甚至为多支冠脉狭窄,其次不稳定性心绞痛易发生急性心肌梗死或猝死的潜在的病理解剖基础,应尽早行冠脉造影以便进一步治疗,必要时行介入治疗,三支病变拟行冠状动脉旁路移植术。     

Comparison of clinical characteristics and prognosis in Taiwanese patients with coronary vasospastic angina pectoris without significant fixed coronary artery disease versus patients with significant fixed coronary artery disease and either stable angina pectoris or acute coronary syndromes

BACKGROUND: Limited information is available comparing the clinical characteristics and prognosis for patients with coronary vasospastic angina in the absence of hemodynamically significant coronary artery disease (CAD) (defined as >50% stenosis) versus patients with significant fixed CAD presenting with either stable angina pectoris (SAP) or acute coronary syndromes (ACS). METHODS: Patients who underwent cardiac catheterization for suspected ischemic heart disease between August 1999 and February 2003 were followed clinically. For patients without hemodynamically significant CAD, a provocation test for coronary vasospasm was undertaken using a step-wise dose of intracoronary ergonovine administration. RESULTS: A total of 1134 patients were enrolled in the final analysis and stratified into 4 diagnostically distinct groups: control group (n = 239; mild CAD without coronary vasospasm); vasospasm group (n = 284; coronary vasospastic angina pectoris without hemodynamically significant CAD); SAP group (n = 110; hemodynamically significant CAD with SAP); ACS group (n = 501; hemodynamically significant CAD with ACS). Comparison of these 4 groups revealed that the ACS patients were more likely to be male, current smokers, and have hypercholesterolemia. In addition, this group had a significantly higher incidence of typical angina pectoris, 3-vessel CAD, and lower left ventricular ejection fraction. Between-group comparison revealed that vasospasm patients had a significantly higher incidence of early morning angina pectoris. Multivariate analysis showed that current smoking was the most independent risk factor associated with the diagnosis of coronary vasospastic angina pectoris in patients without hemodynamically significant CAD. During a median follow-up period of 49 months, recurrent angina pectoris was noted in patients from the control (n = 6; 3%), SAP (n = 9; 8%), vasospasm (n = 30, 11%), and ACS groups (n = 92; 18%); with nonfatal myocardial infarction identified during follow-up in the SAP (n = 5; 5%), vasospasm (n = 3; 1%), and ACS groups (n = 37; 7%). In addition, 29 and 3 cardiac deaths occurred in the ACS and SAP groups, respectively, whereas there were no such mortalities in the control and vasospasm groups. CONCLUSIONS: Early morning angina pectoris and cigarette smoking were the most common clinical characteristics in patients with coronary vasospasm. These patients had an excellent prognosis despite the possibility of recurrences of vasospastic angina pectoris.