title: Limitations of medical therapy in patients with pure coronary spastic angina.
abstract: 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.
authors.affiliation: Department of Cardiology, Saiseikai Saijo Hospital, Saijo City, Japan.
authors.forename: Shozo
authors.initials: S
authors.lastname: Sueda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kohno
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Fukuda
authors.forename: Kouki
authors.initials: K
authors.lastname: Watanabe
authors.forename: Naoto
authors.initials: N
authors.lastname: Ochi
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kawada
authors.forename: Tadao
authors.initials: T
authors.lastname: Uraoka
mesh_terms: 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
chemical_list: D002121:Calcium Channel Blockers; D007548:Isosorbide Dinitrate; D000109:Acetylcholine