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Organic coronary stenosis in Prinzmetal's variant angina
Insights
Fixed coronary lesions are common in variant angina patients and significantly impact long-term survival. Multivessel coronary stenoses are associated with poorer prognosis compared to single-vessel disease or normal arteries.
Area of Science:
- Cardiology
- Vascular Medicine
- Clinical Research
Background:
- Variant angina is characterized by transient ischemic episodes at rest.
- The role of fixed coronary artery lesions in variant angina remains debated.
- Understanding the prevalence and impact of coronary stenoses is crucial for patient management.
Purpose of the Study:
- To evaluate the prevalence, extent, severity, and prognostic implications of organic coronary stenoses in patients with variant angina.
- To compare outcomes between patients with normal/single-vessel lesions and those with multivessel stenoses.
- To identify predictors of survival in variant angina.
Main Methods:
- Retrospective analysis of 162 patients with documented transient ST segment elevation during hospitalization.
- Coronary angiography to assess the presence and severity of coronary stenoses.
- Follow-up for up to 82 months using Kaplan-Meier survival analysis and Cox regression.
Main Results:
- Organic coronary stenoses were frequent, with only 7% of patients having normal coronary arteries.
- Patients with multivessel coronary stenoses (group 2) had a significantly lower 5-year survival rate (80.1%) compared to group 1 (94.6%).
- The extent of coronary lesions was an independent predictor of survival.
Conclusions:
- Fixed organic coronary stenoses are common in variant angina.
- Multivessel coronary stenoses are associated with a worse long-term prognosis in patients with variant angina.
- Coronary lesion severity is a critical factor influencing survival outcomes.
Abstract:
Functional factors are known to precipitate ischemic episodes at rest in variant angina, but the role of fixed coronary lesions is still debated. The prevalence, extent, severity and prognostic implications of organic coronary stenoses in variant angina were evaluated in 162 patients with transient ST segment elevation documented during hospitalization. Seventy-eight patients had normal coronary arteries or single-vessel coronary lesions (group 1) and 84 patients had multivessel coronary stenoses (group 2). Both groups were followed up for 82 +/- 41 months. Angiographically normal coronary arteries were observed in only 11 patients (7%). In 59 patients with single-vessel coronary stenoses, the internal luminal diameter was reduced by 51 +/- 12%. There were 20 deaths (16 from cardiac causes) during the 5-year follow-up. Kaplan-Meier survival analysis revealed a significantly lower 5-year survival rate in group 2 (80.1%) compared to group 1 (94.6%, p = 0.006 by Mantel-Haenszel test). If only cardiac causes of death were considered, the 5-year survival rate was still lower in group 2 (84.0%) than in group 1 (97.1%, p = 0.004). Considering both revascularized patients and those treated medically for the entire duration of the follow-up, the survival rate was significantly lower in group 2 than in group 1. Finally, the extent of coronary lesions was an independent predictor of survival by Cox multivariate regression analysis. Organic coronary stenoses are frequent in patients with variant angina and are important for the long-term prognosis.