CLINICAL AND ANGIOGRAPHIC CHARACTERISTICS OF PATIENTS WITH MULTIVESSEL CORONARY SPASM IN VARIANT ANGINA - SIGNIFICANCE OF PROGRESSIVE COURSE OF ANGINA AND DISEASE-ACTIVITY

The purpose of this study was to investigate the incidence of multives sel coronary spasm and compare the clinical characteristics between pa tients with and without multivessel coronary spasm. In variant angina, it is controversial whether coronary hyperreactivity to vasoconstrict or stimuli is localized to a segmental lesion in only one coronary art ery. Moreover, the clinical characteristics of patients with multivess el coronary spasm have never been investigated. Sixty-three patients ( 51 men and 12 women; mean age, 56 years; range 35-72 years) with varia nt angina and documented ST-segment elevation during a spontaneous att ack underwent spasm provocation testing with selective intracoronary i njection of ergonovine. All but 4 patients who experienced spontaneous attacks during cardiac catheterization had induced coronary spasm ass ociated with ST-segment elevation and chest pain. Multivessel coronary spasm was found in 27 (43%) of 63 patients. By univariate analysis, a high frequency of angina (greater-than-or-equal-to 3 times/week), occ urrence of a spontaneous attack within 24 hours after withdrawal of me dication, a long history of angina and a progressive course of angina were significantly associated with multivessel coronary spasm. Multiva riate analysis indicated a positive correlation between multivessel co ronary spasm and progressive angina. Multivessel coronary spasm was fo und in 43% of patients with variant angina. Patients with multivessel coronary spasm have some unique clinical features. These results may i ncrease the understanding of the pathophysiology and natural course of variant angina.