Variant Angina with Angiographically Normal or Near-Normal Coronary Arteries: A 10-year Experience

To determine clinical and laboratory characteristics and prognosis of consecutive Taiwanese patients presenting with variant angina and normal or near-normal coronary arteries. A total of 1,329 consecutive patients with acute coronary syndrome who underwent coronary angiography at out hospital were retrospectively screened and reviewed. Over a 10-year period at our hospital, variant angina developed in 14 patients who had normal or near-normal coronary arteries. Of the 14 patients included in the study, mean age 52 years, 10 patients were men and 9 of the 10 men were cigarette smokers. All but one patient developed chest pain between midnight and morning. Twelve patients whose blood tests for high-sensitivity C-reactive protein on the second day after admission had a mean level of 5.5 mg/L. The electrocardiographic location of transient ST-segment elevation was in the anterior leads in 8 patients, inferior leads in 3 and both anterior and inferior leads in 3. Spasm of left anterior descending artery was the most common finding in these cases. Three patients developed atrial fibrillation and 2 patients had atrioventricular block during variant angina. During a median follow-up period of 54 months, no patient expired, suffered a nonfatal infarction, or recurrent variant angina. One percent of patients with acute coronary syndrome had variant angina with normal or near-normal coronary arteries. The variant angina with normal or near-normal coronary arteries could be found in 2% of the patients with ST-segment elevation acute coronary syndrome. These patients had a good prognosis.