Limitations of medical therapy in patients with pure coronary spastic angina.
OBJECTIVE
To assess the efficacy of medication for the treatment of pure coronary spastic angina, 71 consecutive patients with this diagnosis who had undergone coronary arteriography in a hospital with a follow-up of at least 2 years were studied.


RESULTS
All 71 patients without significant organic stenosis were treated with long-acting calcium antagonists. The disappearance of chest pain attacks while receiving medical therapy was observed in 27 patients (38%), whereas the remaining 44 patients (62%) had chest pain attacks. Of special interest, 30 patients had more than one attack per month irrespective of the administration of calcium antagonists or isosorbide dinitrate. Medical treatment showed a good response in female patients (63% vs 31%, respectively; p < 0.05) and those with ST-segment elevation during selective spasm provocation tests (63% vs 30%, respectively; p < 0.05). In contrast, patients with a longer history of chest pain attacks before hospital admission and those with diffuse spasms (77% vs 34%, respectively; p < 0.01) had poor responses to medical treatment. In this study, neither sudden death nor acute myocardial infarction was observed during the follow-up periods.


CONCLUSIONS
The limitations of medical therapy, including the administration of long-acting calcium antagonists, were observed in 30 of 71 patients (42%) with pure coronary spastic angina. Medical treatment was effective in only 38% of patients with pure coronary spastic angina in Japan.
Sueda
Shozo
S
Department of Cardiology, Saiseikai Saijo Hospital, Saijo City, Japan.
Kohno
Hiroaki
H
Fukuda
Hiroshi
H
Watanabe
Kouki
K
Ochi
Naoto
N
Kawada
Hiroyuki
H
Uraoka
Tadao
T
D000109:Acetylcholine; D000368:Aged; D000788:Angina Pectoris, Variant / Q000000981:diagnostic imaging / Q000188:drug therapy*; D002121:Calcium Channel Blockers / Q000009:adverse effects / Q000627:therapeutic use*; D017023:Coronary Angiography / Q000187:drug effects; D003329:Coronary Vasospasm / Q000000981:diagnostic imaging / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006801:Humans; D007548:Isosorbide Dinitrate / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D002121:Calcium Channel Blockers; D007548:Isosorbide Dinitrate; D000109:Acetylcholine