Heart 1999;81:528-532 ( May )
Long lasting spasticity in controlled vasospastic angina
O Ueda,a
K Kohchi,a
Y Kishi,b
F Numanob
a Department of
Cardiology, Chiba Tokushukai Hospital, 1-27-1 Narashinodai,
Funabashishi, Chiba 274 8503, Japan, b The Third Department of Internal Medicine, Tokyo
Medical and Dental University, Tokyo, Japan
Correspondence to: Dr Ueda.
Accepted for publication 4 December 1998
OBJECTIVE
To evaluate
changes in coronary artery spasticity in patients with vasospastic
angina who had been stable for years under continuous drug treatment.
METHODSFollow up
coronary angiography was performed under intracoronary ergonovine
provocation in 27 well controlled patients with vasospastic angina and
no organic stenosis; the tests were done > 24 months after the
initial coronary angiography, in which occlusive spasm had been induced
by the same regimen of ergonovine provocation.
RESULTSThe mean (SD)
follow up period was 47.2 (21.6) months. All patients had been free
from angina attack for more than 24 months under treatment with
antianginal drugs. During this follow up period, organic stenosis
developed in only one case. Occlusive spasm was observed during follow
up coronary angiography in 23 patients. Spasm with 90% narrowing was
observed in three other patients, and diffuse significant narrowing was
seen in the final patient. No significant difference was found in
spasticity (p = 0.75) between the initial and the follow up tests.
CONCLUSIONSRepeated
ergonovine provocation during coronary angiography after a
controlled period of several years showed that coronary spasm remains
inducible in most patients. Discontinuance of drug treatment
during the remission from anginal attacks achieved by medication may
put the patient at high risk.
Keywords:
vasospastic angina;
ergonovine;
angiography
© 1999 by Heart
