VARIANT ANGINA

COMPARISON OF PATIENTS WITH AND WITHOUT FIXED SEVERE CORONARY ARTERY DISEASE

Abstract

Introduction: The syndrome of variant angina occurs in patients with a
wide spectrum of coronary artery obstructions, ranging from normal coronary arteries to severe 3-vessel coronary artery
disease (CAD). Treatment of these patients is, in large part, determined by the extent and severity of the underlying
fixed coronary obstructions. Objective: To determine the clinical features of variant angina with and without fixed severe
coronary artery disease. Setting: Nishtar Hospital, Multan. Duration: Two years. Study design: Descriptive,
comparative analytical study. Material & methods: Sample size 108 patients. Sampling technique: Convenient
probability sampling done. Results: 43 patients with variant angina who had less than 50% fixed coronary luminal
diameter narrowing (group-I) were compared with 65 patients with variant angina who had 70% or greater diameter
narrowing (group-II). Statistically significant differences were found in 3 clinical features between group-I and group-II
i.e. (1) a more than 3 months history of angina at rest before diagnosis (80% vs 23%, P <0.001); (2) an abnormal
electrocardiogram at rest (19 vs 48%, P <0.01). (3) an abnormal stress test (26% (8 of 30) vs 84% (15 of 18), P <0.01.
However, these features were not clinically reliable in separating patients with variant angina with and without fixed
severe obstructions because of overlap between the two groups. No difference was found between the 2 groups in age,
sex, predominant symptoms at the time of catheterization, history of exertional angina, syncope with angina, prolonged
angina, previous artery disease. Conclusion: Coronary arteriography should be performed to define the underlying
coronary anatomy and to determine optimal therapy in patients with variant angina.