Importance of coronary spasm for recurrences following percutaneous transluminal coronary angioplasty (PTCA).

To examine the importance of coronary spasm for recurrences following coronary angioplasty, the incidence of spontaneous and ergonivine-provoked coronary spasm was studied, during initial and 6 months follow-up coronary angiography, in a consecutive series of 102 patients with single-vessel disease and successful coronary angioplasty. Repeat angiography demonstrated restenosis in 35 patients (34%). In patients with no demonstrable coronary spasm before and 6 months after PTCA, restenosis occurred in 23% (14/61). The recurrence rate for patients with spasms only before PTCA was similar (29%; 6/21). An increase of recurrences was observed in patients with coronary spasm before and 6 months after PTCA (69%; 9/13) and was extremely high in patients with detectable spasms only after PTCA (86%; 6/7). The importance of the severity of underlying coronary stenosis as regards the ergonovine testing result, demonstrated no relationship between the degree of underlying stenosis and the incidence of provokable coronary spasms. Thus, coronary spasms provokable only before PTCA do not increase the risk for recurrences. Spasms persisting after PTCA or seen only after the procedure are associated with a significantly higher rate of restenoses.