FLUCTUATION OF SPASTIC LOCATION IN PATIENTS WITH VASOSPASTIC ANGINA -A QUANTITATIVE ANGIOGRAPHIC STUDY

Objectives. This study sought to determine whether the location of cor onary spastic activity may change over time in patients with persisten t variant angina. Background. Although electrocardiographic studies ha ve provided indirect evidence to indicate that the location of ischemi a may change in patients with variant angina, it has not been tested b y quantitative angiography whether the location of vasospastic activit y may change over time. Methods. Paired ergonovine provocation tests a nd coronary angiography were performed at a mean (+/-SD) interval of 4 3 +/- 13 months apart in patients with persistent symptoms of vasospas tic angina in the absence of significant atherosclerosis. A total of 8 7 spastic and nonspastic segments of 87 major vessels in 29 patients w ere analyzed by quantitative angiography at baseline, after the admini stration of ergonovine and after isosorbide dinitrate at the initial a nd follow up tests. Results. In 13 patients (group 1), coronary spasm was observed in the same 16 coronary segments at both the initial and follow-up ergonovine provocation tests. In 16 patients (group 2), the following angiographic changes occurred between the initial and follow up tests in 48 major vessels: Of the 23 segments that developed spasm at the initial test, 10 did not have spasm at the follow up test; of the 25 vessels that did not demonstrate spasm on the initial test, 12 demonstrated spasm on the follow up test (a new site of spasm). Thus, in 22 (46%) of 48 vessels, fluctuation of spastic location was observe d at follow-up. Conclusions. Quantitative coronary angiography and rep eated ergonovine tests revealed that some patients with persistent vas ospastic angina demonstrate fluctuation of vasospastic location, where as others exhibit a fixed location of vasospasm. Vasospastic angina ma y not only be a transient disease restricted in location, but may also be a persistent and variable condition involving multiple vessels ove r many years. (J Am Coll Cardiol 1995;26:1606-24)