Clinical Characteristics and Outcomes in Patients with Variant Angina

Focal Objectives: We retrospectively analyzed the clinical and angiographical characteristics between variant angina and non-variant angina. Methods : We diagnosed 902 patients with coronary spastic angina from Jan 1991 to Mar 2019. Variant angina was observed in 105 patients, while the remaining 797 patients had non-variant angina. Acetylcholine was injected in incremental doses of 20/50/100/200 μg into the left coronary artery (LCA) and 20/50/80 μg into the right coronary artery (RCA), whereas 64 μg ergonovine was administered into the LCA and 40 μg into the RCA. Positive spasm was defined as > 90% stenosis and usual chest pain or ischemic ECG changes. Clinical outcomes under medications were investigated during 1462±960 days of follow-up. Results : There were no differences regarding the clinical characteristics between the two groups. Significant organic stenosis was frequently observed in patients with variant angina compared with non-variant angina. Although the administration of two types of calcium channel blocker (CCB)s, nitrates, and aspirin was markedly higher in patients with variant angina than in those with non-variant angina, the number of clinical outcomes including sudden cardiac death, acute coronary syndrome, ventricular fibrillation, and percutaneous coronary intervention was significantly higher in patients with variant angina than in those with non-variant angina. Clinical outcomes in patients with variant angina and organic stenosis was markedly worse than other 3 groups: variant angina with nonorganic stenosis, non-variant angina with organic stenosis, and non-variant angina and nonorganic stenosis. Conclusions : Clinical outcomes in patients with variant angina was unfavorable compared with those with non-variant angina. Variant angina requires more percutaneous coronary intervention therapy compared with non-variant angina.