During a 4-year period, 33 patients with angiographic
coronary artery spasm in the absence of significant fixed occlusive disease were reviewed. Sixteen patients had typical variant angina and 17 had
catheter-induced
spasm. All patients had one or more episodes of rest angina. Left ventriculography demonstrated
mitral valve prolapse in 14 patients (42%) and end-systolic cavity obliteration in six (18%).
Spasm was demonstrated to occur in the right coronary artery in 26 patients and in the left coronary artery in seven. Two patients had multivessel
spasm. Comparing patients with variant angina and
catheter-induced
spasm demonstrated no significant difference in clinical, ECG, or angiographic parameters. Two patients with
catheter-induced
spasm had healed
myocardial infarctions and both developed spontaneous non
catheter-induced
spasm in the
infarct vessel. The majority of patients responded to long-acting
nitrate therapy, though those with
catheter-induced
spasm tended to have more recurrent
chest pain. Six patients were placed on
calcium antagonist drugs with marked symptomatic improvement in five. This study suggests that patients with
catheter-induced
spasm are similar to those with variant angina and its angiographic documentation may be a marker for the identification of patients with vasospastic angina.