Different responses of coronary artery and internal mammary artery bypass grafts to ergonovine and nitroglycerin in variant angina.

The dynamic responses of a coronary artery and an internal mammary artery (IMA) graft to pharmacological intervention were examined by arteriography in 5 patients with variant angina who had undergone coronary artery bypass grafting with an in situ IMA to the left anterior descending coronary artery. Preoperative electrocardiographic findings included elevated ST segments in chest leads during attacks of angina, and all patients had severe fixed lesions in addition to marked spasm of the left anterior descending coronary artery after the administration of ergonovine maleate. Postoperatively with ergonovine stimulation, complete occlusion or marked subtotal narrowing was again observed at the primary fixed lesion in the proximal portion of the left anterior descending coronary artery, but the IMA graft and the coronary artery distal to the anastomotic site maintained satisfactory patency with no further occurrence of anginal pain or ST segment elevation. By computer-assisted graphic analysis, which allows highly reproducible measurements of vascular internal diameters, the diameter of the IMA showed only small changes under ergonovine (p = not significant) or nitroglycerin (p less than 0.05) stimulation in contrast to the marked vascular reactivity of the coronary artery (p less than 0.05 and less than 0.01, respectively). These findings indicate that the IMA graft is unresponsive to ergonovine at least in the amount required to produce coronary artery spasm in patients with variant angina and fixed lesions. The IMA graft appears to function well from a clinical and pharmacological viewpoint in patients with variant angina.