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Long-term prognosis of vasospastic angina without significant atherosclerotic coronary artery disease
K Egashira1, Y Kikuchi, T Sagara
1Department of Internal Medicine, Kyushu Kohsei-Nenkin Hospital, Kitakyushu City, Japan.
Insights
Long-term prognosis for vasospastic angina patients without significant coronary artery disease is good. Calcium antagonist treatment effectively reduced angina symptoms, with low rates of myocardial infarction and sudden death.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Vasospastic angina (VSA) can affect patients without obstructive coronary artery disease.
- Understanding the long-term outcomes of VSA is crucial for patient management.
Purpose of the Study:
- To evaluate the long-term prognosis of patients diagnosed with vasospastic angina.
- To assess the effectiveness of calcium antagonists in managing VSA.
Main Methods:
- A cohort of 90 patients with VSA and no significant coronary artery disease were followed for a mean of 4 years.
- All patients received treatment with calcium antagonists for their angina episodes.
- Outcomes including myocardial infarction, sudden death, and arrhythmias were recorded.
Main Results:
- One patient experienced myocardial infarction, and two patients died suddenly during the follow-up period.
- Serious arrhythmias, such as ventricular tachycardia and complete atrioventricular block, were more frequent in sudden death patients.
- Calcium antagonists effectively reduced angina severity and frequency in all treated patients.
Conclusions:
- Vasospastic angina without significant coronary artery disease generally has a good long-term prognosis.
- Calcium antagonist therapy is beneficial in managing VSA symptoms and improving outcomes.
- Vigilant monitoring for serious arrhythmias is warranted in VSA patients.
Abstract:
Long-term prognosis of 90 patients with vasospastic angina without significant coronary artery disease (less than 50% reduction in luminal diameter) was examined for a mean follow-up period of 4 years. All patients had episodes of angina at rest and were treated with calcium antagonists. One patient developed myocardial infarction and 2 died suddenly during the follow-up period. In the patient with myocardial infarction, there was an abrupt worsening of angina prior to the infarction despite therapy with a calcium antagonist. One of the sudden death patients discontinued his calcium antagonist before his death. Of the sudden death patients, one had ventricular tachycardia and the other had a complete atrioventricular block during an anginal attack. The incidence of such serious arrhythmias was higher (p less than 0.01) in sudden death patients (2/2) than that in survivors (6/88). The treatment with calcium antagonists reduced the severity and frequency of angina in all patients. These results suggest that long-term prognosis of vasospastic angina without significant coronary artery disease is good as characterized by the low incidence of myocardial infarction and death and the favorable response to treatment with calcium antagonists.