Long-term Follow up in Patients with Vasospastic Angina in Relation to Medication Period and Disease Activity

Kim, Cheol Hong; Ryu, Kyu Hyung; Han, Seong Woo; Park, Kyu Yong; Han, Yun Chang; Hong, Kyung Soon; Doo, Young Cheoul; Han, Kyu Rok; Oh, Dong Jin; Rim, Chong Yun; Koh, Young Bahk; Lee, Yung

Abstract

OBJECTIVES
Clinical course of vasospastic angina is variable : spontaneous remission, persistent angina and progression of disease or death. Several studies from western institutes have been performed on the clinical characteristics and long-term prognosis of patient with coronary vasospasm. In these reports, 53-82% of patients had spontaneous remission. These results may be assumed differ from that of Korean patients with vasospastic angina, but no detailed studies have been reported in Korea. Currently, in patients with vasospastic angina, treatment with calcium antagonists and/or nitrates are effective in reducing the frequency of anginal attacks. And, clinical course and outcome of vasospastic angina may be different from previous western reports thereafter. The purpose of this study is to describe the disease activities and the factors influencing the clinical course of vasospastic angina in relation to medication-period; age, sex, risk factors, extents of coronary vasospasm, initial ischemic events and significance of fixed lesion. Also we tried to determine if clinical or angiographic variables might be useful in predicting the possibility of spontaneous remission for an each patient.
METHODS
Eighty-seven patients with vasospastic angina(M/F ; 58/29, mean age ; 53+/-9 years) were included and all documented coronary vasospasm on the coronary angiogram, spontaneous spasm in 35, positive ergonovine or acetylchoine provocation in 52. Coronary artery spasm was declined as more than 75% reduction in coronary luminal diameter and ST segment changes on electrocardiogram, or typical anginal symptoms together and then narrowed coronary arteries were recovered after intracoronary nitroglycerin. The patients were treated with calcium antagonists(nifedipine, diltiazem, amlodipine and felodipine) and nitrates single or both and were divided into 3 groups according to angina activity : group I, which anginal attacks less than one time monthly, group II, which anginal symptoms occurred in 24-48 hours after withdrawal of medication, group III, which symptoms recurred frequently with the incidence of over one time weekly. After discharge, each patient returned to a medical out-patient department at every 1-2 months.
RESULTS
Age, gender, other coronary risk factors, disease activity of vasospastic angina, initial clinical presentation at admission, coronary angiographic findings, fixed lesion and alcohol-induced anginal attacks were not statistically different among the 3 groups. But admission frequency of group II and III, which had a high anginal activities, were more than that of group I significantly.
CONCLUSION
In the present study, it is concluded that medical treatment in patients with vasospastic angina in Korea may be taken long duration during follow-up period if the patient of group II and III considered to persistent angina group. To assess the prevalence of spontaneous remission, we consider that systematic attempts to taper medication may be done for patient of group I(angina free-on treatment) after absence of anginal attacks for at least one year medication-period.