Clinical and arteriographic features of Prinzmetal's variant angina: documentation of etiologic factors.

Coronary arteriography performed in 17 patients with Prinzmetal's variant angina demonstrated high grade fixed obstructions in 9 patients (Group I) and insignificant or no fixed lesions in 8 patients (Group II). Group I consisted mostly of middle-aged or elderly men with S-T segment elevations in various sites; Group II included five younger women with S-T segment elevations in inferior electrocardiographic leads. In Group I patients, arteriography revealed a discrete high grade lesion located proximally in a major coronary artery in four patients and multivessel involvement in five patients. In Group II patients, spontaneous spasm was documented in three patients and spasm was pharmacologically provoked in two others during arteriography. The current study indicates that spasm is the responsible pathogenetic mechanism of myocardial ischemia in some patients with Prinzmetal angina and that this mechanism may be suspected from the clinical characteristics of these patients.