title: Typical angina without significant coronary stenosis: comparison of clinical profile, circadian presentation, and long-term follow-up between patients with and patients without vasospastic angina.
abstract: OBJECTIVE
  The spectrum of patients with 'angina and normal coronary arteries' ranges from severe vasospasm to atypical chest pain. Among those with typical angina, however, little is known about similarities in the clinical profile and circadian presentation between typical nonvasospastic angina and normal coronary arteries (tANCA) and vasospastic angina (VA).
  
  
  METHODS
  Clinical, ECG, and angiographic features as well as the circadian characteristics of angina were compared between 384 tANCA and 273 VA patients. Follow-up events were also analyzed.
  
  
  RESULTS
  tANCA patients had greater female predominance (61 vs. 18%), higher incidence of dyspnea to moderate exertion (49 vs. 12%), lower incidence of tobacco smoking (25 vs. 67%), but a similar low rate of diabetes (8.9 vs. 4.4%). In both groups, however, dyspnea and smoking were associated with female and male sex, respectively. tANCA patients showed lower but non-negligible frequency of early morning (25 vs. 67%) and evening angina (37 vs. 54%), similar rate of nocturnal angina (47 vs. 50%), and higher rate of emotional angina (49 vs. 31%). Moreover, a high proportion of patients gained pain relief with nitroglycerin (97% in VA, 246/253, and 76% in tANCA, 231/306). At 140 months, frequent angina (>10 episodes/year) was rare (VA: 7.1% vs. tANCA: 6.3%) as was the rate of cardiac death/myocardial infarction (7.3 vs. 6.0%, P=0.524).
  
  
  CONCLUSIONS
  Despite differences in the clinical profile between VA and tANCA patients, there is notable sharing of circadian presentation of rest angina, response to nitroglycerin, and long-term presence and frequency of angina that suggests more similarities in underlying mechanisms than heretofore suspected.
authors.affiliation: Coronary Care Unit, Cardiology Service, Hospital General Universitari Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain. 5751jfb@gmail.com
authors.forename: Jaume
authors.initials: J
authors.lastname: Figueras
authors.forename: Enric
authors.initials: E
authors.lastname: Domingo
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Lidón
authors.forename: Neus
authors.initials: N
authors.lastname: Bellera
authors.forename: David
authors.initials: D
authors.lastname: Garcia-Dorado
mesh_terms: D000328:Adult; D016009:Chi-Square Distribution; D002940:Circadian Rhythm; D017023:Coronary Angiography; D003329:Coronary Vasospasm / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000453:epidemiology; D018450:Disease Progression; D004417:Dyspnea / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D017566:Microvascular Angina / Q000175:diagnosis / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality; D005996:Nitroglycerin / Q000627:therapeutic use; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D014665:Vasodilator Agents; D005996:Nitroglycerin