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[Outcome of vasospastic angina with normal or near-normal coronary arteries (author's transl)]
Insights
Vasospastic angina with normal coronary arteries can have an unfavorable outcome, including death or myocardial infarction. Provocation tests may guide treatment for better long-term results in these patients.
Area of Science:
- Cardiology
- Clinical Medicine
Context:
- Vasospastic angina (VSA) in patients with normal or near-normal coronary arteries presents a diagnostic and therapeutic challenge.
- Understanding the long-term prognosis and effective management strategies for VSA is crucial.
Purpose:
- To investigate the long-term outcome of vasospastic angina in patients with normal or near-normal coronary arteries.
- To evaluate the efficacy of calcium antagonists compared to beta-blockers and the utility of provocation tests in guiding therapy.
Summary:
- This study followed 48 patients with VSA and normal coronaries for a mean of 19.1 months.
- An unfavorable outcome (death, myocardial infarction, refractory angina) occurred in 13 patients, while 16 had a favorable outcome and 16 an intermediate outcome.
- Calcium antagonists showed superiority over beta-blockers but imperfect control; provocation test results correlated with long-term outcomes, suggesting their use as therapeutic guidelines.
Impact:
- The findings highlight the potential for significant morbidity and mortality in VSA patients with normal coronaries.
- Provocation tests may serve as valuable tools for predicting long-term prognosis and tailoring treatment strategies.
- This research supports the use of targeted diagnostic testing to optimize therapeutic interventions for vasospastic angina.
Abstract:
The outcome of vasospastic angina with normal or near-normal coronary arteries was investigated in 48 patients followed up for periods of 3 to 55 months (mean : 19.1 months). The course of the disease was unfavorable in 13 patients, of whom 3 died, 5 developed myocardial infarction and 5 refractory angina. It was favourable in 16 patients who remained asymptomatic for at least 6 months, and intermediate in 16 patients whose anginal attacks became less frequent. Three patients were lost sight of. Calcium antagonists were administered to 32 patients; they proved superior to beta-blockers but imperfectly controlled the course of the disease : the anginal attacks completely ceased in 12 patients, became less frequent in 11 and persisted or became worse in 5. A close correlation was found between long-term outcome and the results of provocation tests performed at the beginning of treatment, and it is proposed that these tests should be used as therapeutic guide-lines.