Current clinical features, diagnostic assessment and prognostic determinants of patients with variant angina

BackgroundClinical characteristics and outcome of patients with variant angina were assessed in the 1970–1980s of the past Century. The recent progress in prevention, diagnosis and treatment of coronary artery disease may have significantly modified clinical characteristics and prognosis of these patients.MethodsFrom January 1991 to December 2002, 202 patients (57.1 ± 12 years; 166 men) were diagnosed to have variant angina at our Institute. Detailed clinical findings and clinical events were prospectively collected for each patient.ResultsThe median time from the first angina attack to diagnosis was 2 months (range 1–276), with diagnosis requiring > 6 months in 31.7% of patients. Coronary angiography (n = 183) showed normal coronary arteries in 42.1% of patients and significant coronary stenoses (> 50%) in 44.3%, with multi-vessel disease in 8.7%. Diagnosis of variant angina was done during coronary angiography in 3% of cases during the first half of the study period, but in 42% of patients in the second half of the study period. Major cardiac events (MCE, i.e., death, resuscitation from cardiac arrest, myocardial infarction) occurred in 41 patients (20.3%), with 43.9% of events occurring within 1 month of symptom onset. The only variable significantly associated with MCE was the detection during angina of ST segment elevation in both anterior and inferior ECG leads (odds ratio 3.24; 95% confidence interval 1.43–7.36; P = 0.005).ConclusionOur data suggest that variant angina is still a frequently overlooked diagnosis, and a timely diagnosis would be crucial to prevent early life-threatening events. Patients with diffuse ST segment elevation on ECG are those at the highest risk of MCE, independently of angiographic findings.