Patients who underwent cardiac catheterization for suspected
ischemic heart disease between August 1999 and February 2003 were followed clinically. For patients without hemodynamically significant CAD, a provocation test for
coronary vasospasm was undertaken using a step-wise dose of intracoronary
ergonovine administration.
RESULTS: A total of 1134 patients were enrolled in the final analysis and stratified into 4 diagnostically distinct groups: control group (n = 239; mild CAD without
coronary vasospasm); vasospasm group (n = 284; coronary vasospastic
angina pectoris without hemodynamically significant CAD); SAP group (n = 110; hemodynamically significant CAD with SAP); ACS group (n = 501; hemodynamically significant CAD with ACS). Comparison of these 4 groups revealed that the ACS patients were more likely to be male, current smokers, and have
hypercholesterolemia. In addition, this group had a significantly higher incidence of typical
angina pectoris, 3-vessel CAD, and lower left ventricular ejection fraction. Between-group comparison revealed that vasospasm patients had a significantly higher incidence of early morning
angina pectoris. Multivariate analysis showed that current smoking was the most independent risk factor associated with the diagnosis of coronary vasospastic
angina pectoris in patients without hemodynamically significant CAD. During a median follow-up period of 49 months, recurrent
angina pectoris was noted in patients from the control (n = 6; 3%), SAP (n = 9; 8%), vasospasm (
n = 30, 11%), and ACS groups (n = 92; 18%); with nonfatal
myocardial infarction identified during follow-up in the SAP (n = 5; 5%), vasospasm (n = 3; 1%), and ACS groups (n = 37; 7%). In addition, 29 and 3 cardiac deaths occurred in the ACS and SAP groups, respectively, whereas there were no such mortalities in the control and vasospasm groups.
CONCLUSIONS: