Organic coronary stenosis in Prinzmetal's variant angina

Functional factors are known to precipitate ischemic episodes at rest in variant angina, but the role of fixed coronary lesions is still debated. The prevalence, extent, severity and prognostic implications of organic coronary stenoses in variant angina were evaluated in 162 patients with transient ST segment elevation documented during hospitalization. Seventy-eight patients had normal coronary arteries or single-vessel coronary lesions (group 1) and 84 patients had multivessel coronary stenoses (group 2). Both groups were followed up for 82 +/- 41 months. Angiographically normal coronary arteries were observed in only 11 patients (7%). In 59 patients with single-vessel coronary stenoses, the internal luminal diameter was reduced by 51 +/- 12%. There were 20 deaths (16 from cardiac causes) during the 5-year follow-up. Kaplan-Meier survival analysis revealed a significantly lower 5-year survival rate in group 2 (80.1%) compared to group 1 (94.6%, p = 0.006 by Mantel-Haenszel test). If only cardiac causes of death were considered, the 5-year survival rate was still lower in group 2 (84.0%) than in group 1 (97.1%, p = 0.004). Considering both revascularized patients and those treated medically for the entire duration of the follow-up, the survival rate was significantly lower in group 2 than in group 1. Finally, the extent of coronary lesions was an independent predictor of survival by Cox multivariate regression analysis. Organic coronary stenoses are frequent in patients with variant angina and are important for the long-term prognosis.