Long-Term Outcome Of 277 Patients With Spasm Of Normal Or Minor Diseased Coronary Arteries

The outcome of patients presenting with spasm of normal or subnormal coronary arteries is only known in small series of patients at medium-term. The authors reviewed the outcome of 277 successive patients over an average period of 86 +/- 43 months (12 to 174 months). There were 206 men and 71 women with a mean age of 54 +/- 9 years. Coronary angiography was performed in all cases and did not show any stenosis greater than 50 %. Spasm was documented during coronary angiography in 157 cases (57 %) by a positive Methergin test after coronary angiography in 113 cases (41 %) and by an ECG recording of Prinzmetal angina in 7 cases (2.5 %). Nearly all patients (264: 95 %) were treated by calcium antagonists. At the end of follow-up, there were : 35 lost to follow-up (12.6 %), 20 deaths (7.2 %) of which 10 were cardiac (3.6 %), 18 myocardial infarctions (6.5 %) : 11 had repeat coronary angiography which showed one or more new significant (> 70 %) coronary lesions in all cases; 109 patients had persistence of chest pain (39 %). The severity of symptoms in 52 cases (over one attack of chest pain per month) led to repeat coronary angiography which showed significant coronary disease in 19 cases; 95 patients (34 %) were asymptomatic. A multivariate statistical analysis showed hypertension or subnormal appearances on the initial coronary angiography to be significant predictive factors for new coronary events (death, myocardial infarction or angina requiring repeat coronary angiography). The authors conclude that coronary spasm of angiographically normal or subnormal arteries is only well controlled at long-term in 39 % of patients not lost to follow-up and is responsible for death or myocardial infarction in 11.6 % of cases (nearly 1.5 % per year).