Circulation, Vol 85, 619-626, Copyright © 1992 by American Heart Association
JC Kaski, D Tousoulis, E McFadden, F Crea, WI Pereira and A Maseri
BACKGROUND. It has been suggested that recurring coronary artery spasm may
lead to the development of fixed atherosclerotic coronary obstructions.
METHODS AND RESULTS. We studied 10 patients with typical Prinzmetal's
variant angina in whom the disease remained active for years and in whom
occlusive coronary spasm occurred reproducibly at the same arterial site
during repeat coronary arteriography (25 +/- 12 months after initial
angiography). At initial evaluation, four patients had significant (greater
than or equal to 50% fixed coronary diameter reduction) one-vessel coronary
artery disease, and six had nonsignificant disease. Spasm developed at
stenotic sites (20-65% diameter reduction) in nine patients and at an
angiographically normal site in one patient. Progression of coronary
disease was assessed in 62 segments: 10 spastic (of which nine were
stenotic) and 52 nonspastic (eight stenotic and 44 angiographically
normal), using computerized arteriography. Mean diameters (millimeters) of
spastic segments, nonspastic stenoses, and angiographically normal
nonspastic segments were not significantly different at first and second
arteriograms (1.52 +/- 0.14 versus 1.43 +/- 0.21, 1.32 +/- 0.17 versus 1.12
+/- 0.23, and 2.40 +/- 0.12 versus 2.42 +/- 0.12, respectively). Stenosis
progression (from 65% diameter reduction to total occlusion) occurred in
one patient at a spastic site and in two at nonspastic sites (from 34% to
65% and from 84% to 100%). Complicated stenoses suggestive of plaque
fissuring were not observed during the study. CONCLUSIONS. In patients with
chronic Prinzmetal's variant angina without myocardial infarction, stenosis
progression was not frequently observed at spastic sites despite the
recurrence of focal coronary spasm over relatively long periods of time.
ARTICLES
Variant angina pectoris. Role of coronary spasm in the development of fixed coronary obstructions
Cardiovascular Research Unit, Royal Postgraduate Medical School, Hammersmith Hospital, London, England.
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