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Clinical characteristics and long-term survival of patients with variant angina
Insights
Surgical treatment for variant angina shows improved survival and fewer heart attacks compared to medical management, especially when obstructive coronary artery disease is present. Variant angina patients face higher risks than nonvariant angina patients.
Area of Science:
- Cardiology
- Cardiovascular Surgery
Background:
- Variant angina (Prinzmetal's angina) is a clinical syndrome characterized by reversible coronary artery spasm.
- Understanding the long-term outcomes of different treatment strategies is crucial for patient management.
Purpose of the Study:
- To compare the long-term outcomes of medical versus surgical treatment in patients with variant angina.
- To identify prognostic factors influencing survival and infarction-free survival in variant angina.
Main Methods:
- Retrospective study of 109 consecutive patients with variant angina undergoing cardiac catheterization over 11 years.
- Follow-up for at least 6 months or until death, with a subset followed for 5+ years.
- Comparison of survival and infarction rates between medically and surgically treated groups, and analysis of prognostic factors using the Cox model.
Main Results:
- Surgically treated patients (n=48) had a 1-year survival probability of 0.94, with minimal perioperative events and no deaths post-discharge.
- Medically treated patients (n=62) had lower survival probabilities (0.88 at 1 year, 0.77 at 5 years) and experienced more nonfatal myocardial infarctions and deaths, particularly within the first 6 months.
- Presence of fixed obstructive coronary artery disease was the most significant negative prognostic factor in medically treated patients, with substantially lower infarction-free survival.
Conclusions:
- Surgical intervention for variant angina appears to offer superior long-term survival and reduced infarction rates compared to medical therapy.
- Variant angina patients with significant obstructive coronary artery disease have a poorer prognosis, underscoring the importance of identifying and treating this subgroup effectively.
- Variant angina patients have a higher risk of adverse events than patients with nonvariant angina coronary disease when other factors are controlled.
Abstract:
We studied 109 consecutive patients with variant angina who underwent cardiac catheterization over an 11 year period. All patients were followed for at least 6 months or until death, and 46 patients (22 treated medically and 24 treated surgically) were followed for 5 years or more. Of the 62 patients initially treated medically, 14 had nonfatal myocardial infarctions (12 within 1 month of catheterization) and 12 died (six within 6 months). Survival probabilities at 1, 3, and 5 years were 0.88, 0.84, and 0.77, respectively. Of the 48 surgically treated patients (including four patients initially treated medically and one initially treated with coronary angioplasty), four had nonfatal infarctions (three in the perioperative period) and three died (all in the perioperative period). The survival probability in these patients at 1 year was 0.94 and remained unchanged at 3 and 5 years. Only one nonfatal infarction and no deaths have occurred in the group of surgically treated patients subsequent to hospital discharge. Three additional patients were treated with coronary angioplasty. The single most important prognostic factor in medically treated patients was the presence or absence of fixed obstructive coronary artery disease. Infarction-free survival probabilities at 1 and 3 years in the 23 patients without significant coronary artery disease were 1.0 and 0.89, compared with 0.51 and 0.46 in the 39 patients with significant coronary disease. Analysis by the Cox model showed that variant angina patients had a higher probability of death and nonfatal infarction than did those with nonvariant angina coronary disease if other important prognostic variables were held constant.(ABSTRACT TRUNCATED AT 250 WORDS)