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Yoo, Shin, Jeong, Yoon, Ha, Cho, and Cheong: Long-Term Prognosis and Clinical Characteristics of Patients With Variant Angina
Original Article
Korean Circulation Journal

Korean Circulation Journal 2008; 38(12): 651-658.

Published online: 31 December 2008

DOI: https://doi.org/10.4070/kcj.2008.38.12.651

Long-Term Prognosis and Clinical Characteristics of Patients With Variant Angina

Sang-Yong Yoo, MD, Dae-Hee Shin, MD, Jeong Ihm Jeong, MD, Juneyoung Yoon, MD, Dong Cheon Ha, MD, Sung-Won Cho, MD, Sang-Sig Cheong, MD

Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, Gangneung, Korea.

Correspondence: Sang-Sig Cheong, MD, Department of Internal Medicine, University of Ulsan College of Medicine, Gangneung Asan Hospital, 415 Sacheon-myeon, Bangdong-ni, Gangneung 210-711, Korea. Tel: 82-33-610-3124, Fax: 82-33-641-8130, sscheong@gnah.co.kr

Received 14 August 2008       Revised 10 September 2008       Accepted 17 September 2008

Copyright © 2008 The Korean Society of Cardiology

Abstract

Background and Objectives

The overall prognosis of patients with vasospastic angina (VA) is relatively good. However, the long-term prognosis and its influencing factors are not well understood in Korean patients.

Subjects and Methods

Between August 1996 and January 2007, 256 consecutive patients with VA were reviewed (215 men, 53±9 years). Coronary spasm was confirmed via intravenous ergonovine provocation in all study patients during coronary angiography. Major adverse cardiac events (MACEs) were defined as myocardial infarction (MI), resuscitation from cardiac arrest, or repeat hospitalization due to recurrent angina.

Results

The 256 patients were followed for an average of 59 months (range, 5 months to 11 years). Thirty-one patients (12.1%) were lost to follow-up. Cardiac deaths occurred in 6 patients (2.3%), non-fatal MIs occurred in 3 patients (1.2%), and MACEs occurred in 52 patients (20.3%). The rates of survival at 1, 3, and 5 years were 99%, 97%, and 97%, respectively, and the rates of MI-free survival at 1, 3, and 5 years were 99%, 96%, and 95%, respectively. Rates of MACE-free survival at 1, 3, and 5 years were 91%, 81%, and 62%, respectively. MI at initial presentation and current smoking were factors significantly associated with MACEs; these factors were also independent predictors of MACE-free survival.

Conclusion

Despite treatment with calcium channel blockers, recurrent episodes of angina were frequently observed, whereas sudden cardiac death and non-fatal MI were rare. Smoking and myocardial infarction at admission were independent risk factors for cardiac death, non-fatal MI, and repeat hospitalization due to recurrent angina in patients with variant angina.

Keywords: Angina pectoris, variant, Prognosis

Figures and Tables

Fig. 1
Survival (top), MI-free survival (middle), and MACE-free survival (bottom) for the entire patient population (256 patients). Each point represents a cardiac death, a non-fatal MI, or recurrent angina requiring repeat admission. MACE: major adverse cardiac event, MI: myocardial infarction.
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Table 1
Clinical characteristics of 256 patients with variant angina
kcj-38-651-i001

CAD: coronary artery disease, ED: emergency department, EF: ejection fraction, HDL-C: high-density lipoprotein-cholestrol, LDL-C: lowdensity lipoprotein-cholesterol, MI: myocardial infarction, OPD: outpatient department, STEMI: ST-segment elevation myocardial infarction, TG: triglyceride

Table 2
Baseline coronary angiographic variables
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Table 3
Ergonovine-provoked coronary angiographic variables
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LAD: left anterior descending artery, LCX: left circumflex artery, RCA: right coronary artery

Table 4
Follow-up medications
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ACEI: angiotensin converting enzyme inhibitor, ARB: angiotensin receptor blocker, BID: twice a day, CCB: calcium channel blocker, QD: once daily, TID: three times a day

Table 5
Clinical events during follow-up
kcj-38-651-i005

MI: myocardial infarction, PCI: percutaneous coronary intervention, SCD: sudden cardiac death

Table 6
Predictors of survival, MI-free survival, and MACE-free survival
kcj-38-651-i006

*95& confidence interval (1.12-4.23), †95% confidence interval (1.20-6.00). CAD: coronary artery disease, MACEs: major adverse cardiac events, MI: myocardial infarction, RR: relative risk

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