PERCUTANEOUS TRANS-LUMINAL CORONARY ANGIOPLASTY FOR THE TREATMENT OF VARIANT ANGINA

Among 268 patients undergoing percutaneous transluminal coronary angioplasty between Feb. 1980 and Jan. 1983, 21 patients had variant angina, documented before angioplasty in 14 and after angioplasty in 7. Before angioplasty, all 21 patients had rest angina and 17 also had effort angina; single vessel coronary artery disease with 60 to 95% stenosis was present in all patients and the left anterior descending coronary artery was involved in all but 3 patients. Coronary angioplasty was successful in 19 patients (90%). Of the 19 patients, 8 remained symptom-free without coronary restenosis after successful angioplasty; in the other 11 patients, angina reappeared within 4 mo., usually in association with restenosis. Of the 9 patients with coronary restenosis, 6 had repeat angioplasty (5 successful procedures and 1 failure), 2 received medical therapy and 1 underwent coronary bypass surgery. Patients in whom Ca channel antagonists were discontinued immediately after angioplasty had an exceedingly high coronary restenosis rate (8 [80%] of 10 successful attempts), but when Ca antagonists were continued for an average of 6 .+-. 4 mo. after angioplasty, the restenosis rate was low (3 [21%] of 14 successful attempts). After a mean (.+-. SD) follow-up period of 33 .+-. 13 mo., 1 patient had died and the 20 others (95%) were symptom-free; among these 20, 15 patients (75%) had been taking no antianginal drugs for more than 1 yr, 2 still received Ca channel antagonists and 3 had had coronary bypass surgery. Repeat coronary arteriography performed 14 .+-. 7 mo. after angioplasty in the 17 patients without angioplasty-related infarction or surgery showed 50% or less coronary stenosis in 13 patients. Thus, coronary angioplasty appears to be an effective alternative therapy for patients with variant angina and organic coronary stenosis.