Mid-term prognosis of medically treated patients with vasospastic angina without significant coronary lesions

초록

documented vasospastic angina without significant coronary stenosis after usual antianginal medical therapy is known to be favorable but the adequate duration of medical therapy and their efficacy with the time are varying among previous reports. Methods: A total 73 pts (39 men, Age; 51.2±10.7 years) without significant coronary stenosis underwent incremental intracoronary acetylcholine (Ach) provocation test (A1 to A3, 20, 50 and 100μg). Critical or total occlusion with ST depression or elevation and/or typical chest pain was considered positive for vasospastic angina. Pts were treated with usual dose of calcium antagonist and/or nitrate up to 6 months and discontinued if pts are completely anginafree state and clinically followed up to one year without medication. Results: Baseline characteristics were similar between two groups. Most pts received diltiazem and isosorbide dinitrate but 16% (12/73) of pts were not able to continue diltiazem due to allergic skin reaction. Eighty one percent (59/73) of pts were angina-free at 6 months medication (Remission group). Among them, only 3 pts (3/59, 5.1%) had recurrences within a month and rest of pts (56/59, 94.9%) remained remission lasting up to 1 year. Nineteen percent (14/73) of pts had persistent angina and could not discontinue medication at 6 months (Non-remission group). There were no death, myocardial infarction and revascularization up to 1 year. There were no significant differences in risk factors, biochemical markers including lipid profile, CRP, ESR, LP(a), homocysteine, HbA1C, CoHb and clinical outcomes between the groups. Conclusions: Six month angina-free remission rate after usual antianginal medication in vasospastic angina was 81%, non-remission rate was 19% and recurrence rate within one year was 5.1%. Vasospastic angina without significant coronary stenosis appears to have a good mid-term prognosis despite the possibility of recurrences.