Published online Sep 26, 2020. doi: 10.4330/wjc.v12.i9.450
Peer-review started: June 28, 2020
First decision: June 15, 2020
Revised: June 28, 2020
Accepted: September 15, 2020
Article in press: September 15, 2020
Published online: September 26, 2020
Patients with vasospastic angina (VSA) sometimes experience prolonged chest symptoms compared with patients with atherosclerotic coronary sclerosis.
The clinical characteristics of VSA patients who have prolonged chest symptoms have not been clarified.
The objective of the present study was to clarify the clinical characteristics, including the results of the spasm provocation test (SPT) and prognosis, of VSA patients with prolonged chest symptoms.
This study included 167 patients with VSA diagnosed by SPT using acetylcholine and recorded the frequencies of positive reactions to a low dose of acetylcholine (L-ACh), total occlusion due to spasm (TOC), focal spasm, and the unavoidable use of nitroglycerin (unavoidable-NTG) during the SPT. The patients underwent a medical interview that investigated the maximum duration and frequency of chest symptoms as well as the frequencies of variant angina and other serious symptoms. The patients were divided into two groups based on the maximal duration: The short-duration group (< 15 min; n = 114) and the long-duration group (≥ 15 min; n = 53). They were also divided into two groups based on the frequency of chest symptoms: The low-frequency group (< 4/month; n = 88) and the high-frequency group (≥ 4/month; n = 79). Furthermore, prognosis including major cardiovascular events was investigated in the studied patients.
The long-duration group showed higher frequencies of other serious symptoms (P < 0.001) and variant angina (P < 0.05) as well as higher frequencies of spasm induction by L-ACh (P < 0.05), TOC (P < 0.05), focal spasm (P < 0.01), and unavoidable-NTG (P < 0.01) than the short-duration group. These parameters did not differ significantly between the low-frequency and high-frequency groups. On the other hand, neither the duration nor frequency of chest symptoms influenced the prognosis in the studied patients.
These findings suggest that patients with VSA who experience prolonged chest symptoms may have more severe characteristics of VSA. Cardiologists should keep this in mind and be more careful in performing the SPT in such patients.