Clinical characteristics associated with myocardial infarction, arrhythmias, and sudden death in patients with vasospastic angina.

Abstract

A total of 349 patients with vasospastic angina were followed in eight centers in Japan for a period of 3.4 + 0.1 years (mean ± SE). Ninety-eight percent of patients were treated with calcium blockers. Twenty-one episodes of myocardial infarction occurred in 18 patients (5%), including two fatal myocardial infarctions. The rate of myocardial infarction was higher (p < .01) in patients with a fixed stenosis of 90% or greater than in patients with a fixed stenosis of less than 90% or normal coronary arteries. Myocardial infarctions occurred predominantly during hospital stays or at a time when the frequency of vasospastic angina increased. There were five sudden deaths (2%). Only one patient suffering sudden death had a fixed stenosis of 75% or greater. Serious arrhythmias were noted in 49 patients (14%). The risk of arrhythmias did not depend on the presence of a fixed stenosis of 75% or greater. These results suggest that cardiac events are rather infrequent in Japanese patients with vasospastic angina who are receiving treatment with calcium blockers and that the presence of a severe fixed stenosis markedly increases the risk of myocardial infarction but not the risk of arrhythmias.

<b>Pure Ventricular Septal Myocardial Infarction in a Young Man With Coronary Artery Ectasia</b>

“…[20][21][22] There have also been reports of a number of myocardial infarction cases directly caused by coronary spasm. 23,24) In clinical practice, cases of vasospastic angina that can be diagnosed and treated are usually caused by spasm occurring in the epicardial arteries that run along the epicardium. In fact, coronary vasospasm occurring in the ventricular septal branch, in which the myocardial perfusion area is relatively small, is unlikely to become a clinical problem.…”

A Case of Acute Myocardial Infarction. Intracoronary Thrombus Formation at a Previously Provoked Vasospasm Site.

“…2,3) In a Japanese multicenter trial, 349 patients with vasospastic angina were followed for a period of 3.4 ± 0.1 years and AMI occurred in 5%. 8) This suggests that coronary artery spasm plays some part in the pathophysiology underlying the development of AMI. Although the exact role played by vasospasm in the onset of AMI could not be defined in the present case, we speculate that prolonged coronary vasospasm with endothelial damage and / or vascular smooth muscle changes may induce intramural plaque rupture and hemorrhage, resulting in acute thrombus formation and the development of a persistent total coronary occlusion.…”

A Case of Urgent PCI after Diagnosis of Acute Coronary Syndrome in a Japanese Man with Unobstructed Coronary Arteries during Posted Overseas in Southeast Asia

“…[1][2][3][4][5] According to the past reports, coronary artery spasm in Japanese has three times higher prevalence than Caucasian. [6][7][8] Yasue and Okumura reported the usefulness of acetylcholine (ACh) spasm provocation test for the induction of coronary artery spasm in patients with variant angina.…”