Late follow-up (41 to 102 months) of medically treated patients with coronary artery spasm and minor atherosclerotic coronary obstructions

• Published in: The American journal of cardiology Vol. 57; no. 15; pp. 1261 - 1263
• Main Authors: Freedman, S.Ben, Richmond, David R., Alwyn, Megan, Kelly, David T.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-06-1986; Elsevier
• Subjects: Antianginal agents. Coronary vasodilator agents; Biological and medical sciences; Cardiovascular system; Coronary Disease - diagnosis; Coronary Disease - drug therapy; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Nifedipine - therapeutic use; Pharmacology. Drug treatments; Prognosis; Verapamil - therapeutic use; Human; Occlusion; Coronary vasodilator agent; Mortality; Calcium antagonist; Coronary artery; Cardiovascular disease; Administration schedule; Coronary heart disease; Long term; Chemotherapy; Atherosclerosis; Organic nitrate; Spasm
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/0002-9149(86)90200-6

From a series of 37 patients with coronary artery spasm and less than 70% diameter narrowing treated initially with verapamil and nitrates, 33 were followed up 41 to 102 months (mean 62). One patient died from carcinoma of the lung and 3 could not be traced. Before diagnosis, 3 had nontransmural myocardial infarction and 10 had either ventricular tachycardia and fibrillation or atrioventricular block. During follow-up there were no cardiac deaths or myocardial infarctions. Asymptomatic periods of more than 3 months occurred in 23 patients during follow-up: 18 with asymptomatic periods of more than 1 year were pain free at the time of study and 5 with asymptomatic periods of 3 to 6 months had infrequent pain. Ten patients had no asymptomatic periods. Symptomatic status at last review was related to initial response to therapy: 13 of 18 patients (72%) currently asymptomatic became asymptomatic with initial therapy compared with 5 of 15 patients (33%) currently experiencing pain (p = 0.06). Twenty-six patients were currently receiving therapy: 22 verapamil, 80 to 640 mg/day (mean 280), 2 nifedipine, 1 diltiazem and amiodarone and 1 isosorbide (15 were receiving additional isosorbide). Twelve patients were not receiving therapy or were receiving very low dosage therapy, including 8 with asymptomatic periods of more than 1 year. Patients with coronary spasm and less than 70% diameter narrowing treated medically have low mortality and morbidity rates over 5-year follow-up. Many have long asymptomatic periods and some may be able to stop therapy indefinitely.