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[Strategy of the treatment of vasospastic angina pectoris]
Insights
Treatment for vasospastic angina varies based on coronary angiography results. Strategies include surgery, angioplasty, calcium antagonists, and nitrates, tailored to lesion type and patient presentation.
Area of Science:
- Cardiology
- Vascular Medicine
Background:
- Vasospastic angina (VSA) diagnosis and treatment strategies are primarily guided by coronary angiography findings.
- A significant proportion of VSA patients exhibit either normal coronary arteries or coexisting atherosclerotic lesions.
Purpose of the Study:
- To outline treatment strategies for vasospastic angina based on coronary angiography results.
- To categorize treatment approaches for patients with VSA, considering the presence and operability of atherosclerotic lesions.
Main Methods:
- Retrospective analysis of 165 patients with angiographically documented coronary spasm.
- Classification of patients into subgroups based on coronary angiography findings: normal arteries, operable atherosclerotic lesions, and inoperable atherosclerotic lesions.
- Description of treatment modalities including aorto-coronary bypass with plexectomy, coronary angioplasty, calcium antagonists, nitrate derivatives, and isolated cardiac denervation.
Main Results:
- Out of 165 patients, 31% had normal coronary arteries, and 69% had atherosclerotic lesions.
- Patients with operable lesions and spasm (47 cases) underwent bypass surgery with spasm prevention or angioplasty.
- Patients with inoperable lesions (67 cases) were treated with calcium antagonists; those with normal arteries (51 cases) received nitrates and calcium antagonists.
Conclusions:
- Treatment for vasospastic angina requires a tailored approach based on angiographic findings, differentiating between atherosclerotic disease and normal coronary arteries.
- Medical management with calcium antagonists and nitrates is crucial, while surgical or interventional procedures are considered for specific patient subgroups.
- Long-term treatment duration for patients with normal coronary arteries remains undetermined, and cardiac denervation is an option for refractory cases.
Abstract:
The strategy of treatment in vasospastic angina is mainly based on the results of coronary angiography. In a series of 165 patients with coronary spasm documented by angiography, 51 patients (31 per cent) had angiographically normal arteries and 69 per cent had organic atherosclerotic lesions. Patients with fixed atherosclerotic lesions were divided in two subgroups depending on whether the lesions were operable. The first subgroup (47 cases) comprised patients with operable lesions and coronary spasm. They underwent aorto-coronary bypass associated with a procedure to prevent spasm (plexectomy) (40 cases). Depending on the site of the lesions, some patients with operable lesions may benefit from coronary angioplasty followed by treatment with calcium antagonist drugs. Patients in the second subgroup (67 cases) with inoperable fixed atherosclerotic lesions were treated with calcium antagonists. Betablockers, which may be considered in organic coronary artery disease, are theoretically contra-indicated because of the vasospastic factor. The remaining patients with "angiographically normal" vessels (51 cases) were treated with nitrate derivatives and calcium antagonists. Treatment should be directed to the suppression of the clinical symptoms and, above all, of ECG signs of ischemia as proved by repeated Holter monitoring. The clinical course may also be assessed by repeated provocation tests. Results may depend on the doses and their timing during the 24 hour period. Duration of treatment in patients with angiographically normal vessels has not yet been established. Isolated cardiac denervation may be indicated in these patients who fail to respond to medical treatment (8 cases).