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Natural history of pure coronary artery spasm in patients treated medically
Insights
Patients with coronary artery spasm often experience angina at rest and frequent spontaneous remissions. Calcium antagonists effectively manage symptoms, unlike nitrates, with low cardiac mortality despite common arrhythmias.
Area of Science:
- Cardiology
- Clinical Medicine
Background:
- Coronary artery spasm, without fixed obstruction, presents a unique clinical challenge.
- Understanding the long-term prognosis and treatment response is crucial for patient management.
Purpose of the Study:
- To analyze the clinical course and outcomes of patients diagnosed with coronary artery spasm.
- To evaluate the efficacy of different medical therapies, specifically nitrates and calcium antagonists.
- To assess the natural history, including remission rates and cardiac mortality.
Main Methods:
- Retrospective analysis of 59 patients with coronary artery spasm and no significant fixed coronary lesions.
- Average follow-up duration of 5.9 years.
- Evaluation of symptom presentation, electrocardiographic changes during angina, treatment responses, and long-term outcomes.
Main Results:
- Angina at rest was the primary symptom in 93% of patients.
- Myocardial infarction occurred in 19%, syncope in 27%, and major arrhythmias in 24%.
- Calcium antagonists were highly effective (83%) compared to long-acting nitrates (31%); 39% experienced spontaneous remission, and cardiac mortality was zero.
Conclusions:
- Pure coronary artery spasm is characterized by recurrent angina, frequent remissions, and a favorable prognosis with calcium antagonist therapy.
- While complications like myocardial infarction and arrhythmias can occur, cardiac mortality is notably low.
- Medical management, particularly with calcium antagonists, is effective in controlling symptoms and improving outcomes.
Abstract:
The clinical course of 59 patients with coronary artery spasm and no fixed severe coronary obstruction was analyzed for an average of 5.9 years. The study group consisted of 27 men and 32 women. Angina at rest was the predominant symptom in 93% of the patients. Myocardial infarction occurred in 19% and syncope during angina in 27%. During spontaneous anginal episodes, 64% of the patients showed ST segment elevation, 17% ST segment depression and 15% no electrocardiographic changes. Major arrhythmias during angina occurred in 24% of the patients. Permanent pacemakers were required in 10% of the patients. Stress tests were positive in 32% of the patients. Long-acting nitrate therapy controlled symptoms in only 31%, and calcium antagonist agents controlled symptoms in 83% of the patients unresponsive to nitrates. Spontaneous remission of angina for at least 1 month while receiving no medical treatment occurred in 39% of the patients. Fifteen percent of patients had an indefinite remission with no recurrence of symptoms for at least 2 years. There were no cardiac deaths. The natural history of medically treated patients with pure coronary spasm is characterized by recurrent angina at rest, frequent spontaneous remission, a poor response to long-acting nitrate therapy and a good response to calcium antagonists. Although myocardial infarction and major arrhythmias are common, cardiac mortality is low in medically treated patients.