Prinzmetal's angina Clinical and anatomic aspects

Area of Science:

• Cardiology
• Internal Medicine

Background:

• Intermediate coronary syndrome can manifest with transient ST elevation, mimicking Prinzmetal's angina.
• Understanding the spectrum of coronary artery anatomy and clinical presentations is crucial for diagnosis and management.

Purpose of the Study:

• To review patients with intermediate coronary syndrome and ST elevation.
• To correlate clinical findings with coronary arteriography results in Prinzmetal's angina.

Main Methods:

• Retrospective review of 120 patients with intermediate coronary syndrome.
• Analysis of clinical data, electrocardiogram treadmill tests, and coronary arteriography findings.
• Documentation of response to nitroglycerin and long-term treatment outcomes.

Main Results:

• Twelve patients (10%) exhibited transient ST elevation consistent with Prinzmetal's angina.
• Nine patients had severe proximal coronary atherosclerosis; three had normal/minimal disease with spasm.
• Clinical predictors for severe coronary artery disease were inadequate for selecting arteriography candidates.

Conclusions:

• Prinzmetal's angina associated with ST elevation shows a wide range of coronary arteriographic findings.
• Nitroglycerin provided initial relief; long-term management varied based on underlying coronary anatomy.
• This syndrome necessitates a comprehensive approach considering both vasospastic and atherosclerotic mechanisms.