["Variant" angina: clinical, electrocardiographic and coronarographic aspects in 40 cases. Considerations for...

Forty patients with chest pain and the electrocardiographic aspects of Prinzmetal's variant angina were studied by means of selective coronary arteriography. In 36 cases (90%) severe coronary lesions could be demonstrated: in 75% of the cases a critical obstruction involved a single major coronary trunk; only in 15% two or more vessels were affected. The vessel most frequently involved by critical obstruction was the left anterior descending (57%); in 5 cases (12.5%) a severe stenosis of the common left coronary trunk was present. In 8 cases critical stenosis were reduced by coronary dilators and were completely resolved in 2 cases. Peripheral lesions with multiple secondary branches involvement were present in none of the cases. A common finding was the absence of evident collateral anastomotic circulation. The comparison of the electrocardiographic manifestations of the anginal crisis and the angiographic findings showed a strict correlation between the area of subepicardial lesion and the major coronary vessel distributing to the corresponding myocardial region. Of the 40 patients, 17 were treated medically and 23 underwent a surgical aortocoronary bypass: the results (surgical mortality 22%; complete success 52%) are compared with those in the literature. Prognosis appears to be severe: coronary arteriography must be performed under criteria of urgency, and the possibilities of treatment must be considered on the basis of the angiographic findings.