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Chest pain after nontransmural infarction: the absence of remediable coronary vasospasm
Insights
Coronary vasospasm is unlikely to cause chest pain in patients with nontransmural myocardial infarction. Antivasospastic therapy did not reduce chest pain or recurrent infarction in this patient group.
Area of Science:
- Cardiology
- Clinical Trials
Background:
- Chest pain is a common symptom following myocardial infarction.
- The role of coronary vasospasm in post-infarction chest pain, particularly in nontransmural myocardial infarction, requires further elucidation.
Purpose of the Study:
- To evaluate the efficacy of prophylactic antivasospastic therapy in reducing chest pain in patients with nontransmural myocardial infarction.
- To determine if coronary vasospasm is a significant contributor to post-infarction ischemia.
Main Methods:
- A double-blind, randomized, placebo-controlled trial was conducted.
- Fifty patients with nontransmural infarction were randomized to receive either nifedipine or a placebo.
- Chest pain episodes, recurrent infarction, and ejection fraction were monitored.
Main Results:
- Chest pain occurred in 52% of nifedipine-treated patients versus 48% of placebo controls.
- Recurrent infarction rates were comparable (12%) between the groups.
- Ejection fraction remained similar and unchanged in both groups throughout the study.
Conclusions:
- Prophylactic antivasospastic therapy with nifedipine did not significantly reduce the incidence of recurrent chest pain or infarction.
- Coronary vasospasm is unlikely to be a primary cause of post-infarction ischemia in patients with nontransmural myocardial infarction.
Abstract:
To assess the contribution of coronary vasospasm to chest pain in patients with nontransmural myocardial infarction, we performed a controlled trial of prophylactic antivasospastic therapy. Fifty patients with nontransmural infarction received either nifedipine or placebo in a double-blind randomized trial. Chest pain occurred in 52% of treated patients (38 episodes on 35 days) compared to 48% of control patients (42 episodes on 33 days). Concurrent therapy was comparable in the two groups. Recurrent infarction occurred in 12% and was comparable between groups. Ejection fraction was similar and was unchanged throughout the study in both groups. Logistic regression failed to identify predictors for recurrent chest discomfort. These data indicate that potent antivasospastic therapy does not reduce the incidence of recurrent chest pain or infarction. Thus, remediable coronary vasospasm is not likely to be a major cause of post infarction ischemia in patients with nontransmural infarction.