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Unstable angina and coronary arteriographic findings with special reference to coronary vasospasm
Insights
Coronary artery stenosis and vasospasm in unstable angina differ by symptom pattern. Ergonovine maleate testing revealed significant variations in organic stenosis and spasm incidence across patient groups.
Area of Science:
- Cardiology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Unstable angina presents with diverse clinical patterns.
- Coronary artery disease (CAD) can involve both fixed organic stenosis and dynamic vasospasm.
- Differentiating these components is crucial for effective management.
Purpose of the Study:
- To investigate the prevalence of organic coronary artery stenosis and ergonovine maleate (EM)-induced vasospasm in patients with different patterns of unstable angina.
- To assess the relationship between clinical presentation and angiographic findings.
Main Methods:
- Cine angiography was performed in 106 patients with unstable angina.
- Patients were categorized into five groups based on angina pattern: new at rest, new with effort, changing from effort to rest, crescendo at rest, and changing from rest to effort.
- Incidence of significant organic stenosis (≥75% and ≥90%) and spasm (≥50% narrowing induced by EM) was determined for each group.
Main Results:
- Significantly lower rates of severe organic stenosis (≥75%) were observed in new angina at rest and crescendo angina at rest compared to changing pattern from rest to effort.
- New angina of effort showed a lower incidence of ≥90% organic stenosis compared to changing pattern from effort to rest.
- High incidences of spasm (≥50%) were provoked by EM in new angina at rest (94%) and crescendo angina at rest (90%), with total obstruction in all cases of changing pattern from rest to effort.
Conclusions:
- Clinical patterns of unstable angina correlate with the underlying pathophysiology, distinguishing between obstructive stenosis and coronary vasospasm.
- Ergonovine maleate testing is valuable in identifying coronary vasospasm as a significant contributor to unstable angina, particularly in rest angina presentations.
- These findings aid in tailoring diagnostic and therapeutic strategies for patients with unstable angina based on their specific symptom characteristics.
Abstract:
The organic stenosis of the coronary artery and vasospasm induced by ergonovine maleate (EM) were examined by cine angiography in 106 cases with unstable angina. They were divided into 5 groups: new angina at rest (27 cases), new angina of effort (15 cases), changing pattern from effort to rest (41 cases), crescendo-type angina at rest (20 cases) and changing pattern from rest to effort (3 cases). The following results were obtained: The incidence of a 75% or more organic stenosis was significantly lower in new angina at rest (52%) and crescendo-type angina at rest (55%) than in changing pattern from rest to effort (95%) (p less than 0.005). The incidence of a 90% or more organic stenosis was significantly lower in new angina of effort than in changing pattern from effort to rest (46% vs 88%, p less than 0.01). On the other hand, the incidence of a 50% or more spastic narrowing provoked by EM was 94% in new angina at rest, 90% in crescendo-type angina at rest, 56% in new angina of effort and 64% in changing pattern from effort to rest. In all 3 cases of changing pattern from rest to effort, total obstructions due to coronary spasm were found. However, there were no significant differences among these groups.