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Variant angina: comparison of patients with and without fixed severe coronary artery disease
Insights
Clinical features do not reliably predict coronary artery disease severity in patients with variant angina. Coronary arteriography is essential for accurate diagnosis and guiding treatment for Prinzmetal's variant angina.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Variant angina, also known as Prinzmetal's angina, is characterized by coronary artery spasms.
- The relationship between clinical presentation and the severity of underlying fixed coronary artery disease is not well understood.
Purpose of the Study:
- To investigate if clinical features of variant angina can predict the severity of fixed coronary artery disease.
Main Methods:
- Compared 43 patients with variant angina and <50% fixed coronary narrowing (Group 1) to 65 patients with variant angina and ≥70% fixed narrowing (Group 2).
- Analyzed clinical features including duration of rest angina, resting ECG, and stress test results.
Main Results:
- A history of prolonged rest angina (>3 months), abnormal resting ECG, and abnormal stress tests were more common in patients with severe fixed coronary narrowing.
- However, these clinical features showed significant overlap between groups and were not reliable for differentiating disease severity.
- No significant differences were observed in demographics, other angina symptoms, or risk factors.
Conclusions:
- Clinical features alone are insufficient to reliably differentiate variant angina patients with normal/mild coronary narrowing from those with severe fixed obstructions.
- Coronary arteriography is crucial for defining coronary anatomy and determining optimal management for variant angina.
Abstract:
To determine if the clinical features of variant angina are predictive of the severity of underlying coronary artery disease, 43 patients with variant angina who had less than 50% fixed coronary luminal diameter narrowing (group 1) were compared with 65 patients with variant angina who had 70% or greater diameter narrowing (group 2). Statistically significant differences were found in 3 clinical features between group 1 and group 2: (1) a more than 3-month history of angina at rest before diagnosis (80% vs 23%, p less than 0.001); (2) an abnormal electrocardiogram at rest (19 vs 48%, p less than 0.01); and (3) an abnormal stress test (26% [8 of 30] vs 84% [15 of 18], p less than 0.01). However, these features were not clinically reliable in separating patients with variant angina with and without fixed severe obstructions because of overlap between the 2 groups. No difference was found between the 2 groups in age, sex, predominant symptom at the time of catheterization, history of exertional angina, syncope with angina, prolonged angina, previous myocardial infarction or risk factors for coronary artery disease. There was also no difference in the location of ST elevation or occurrence of major arrhythmias during angina. Thus, among patients with Prinzmetal's variant angina, those with normal or mildly abnormal coronary arteriograms cannot be differentiated reliably by clinical features from those with fixed severe coronary obstructions. Coronary arteriography should be performed to define the underlying coronary anatomy and to determine optimal therapy in patients with variant angina.