[Coronary arterial spasm and symptomatology in ischemic and non-ischemic heart diseases: study of the ergonovine maleate provocative test in 3,000 consecutive patients].

We performed coronary angiography and ergonovine maleate provocative tests (EM test) for 3,000 consecutive patients to clarify 1) the incidence of coronary arterial spasm and significant fixed organic stenosis in ischemic and non-ischemic heart diseases, and 2) the relation of these angina-inducing mechanism(s) to rest (R), effort and rest (E & R), and effort (E) angina. Coronary arterial spasm was defined as total or subtotal occlusion induced by ergonovine test, and fixed stenosis was defined as stenosis with more than 70% narrowing of luminal diameter measured after administration of isosorbide dinitrate. Subjects consisted of 3,000 consecutive patients and were categorized in four groups including 1,145 patients who had typical angina pectoris (Group I: rest angina 653, effort angina 230, and combined rest and effort angina 262), 398 patients with myocardial infarction (Group II), 648 patients with atypical chest pain (Group III), and 809 patients who eventually had diagnostic catheterization for heart diseases other than of ischemic nature (Group IV). Results were as follows: 1. The incidence of coronary artery spasm was 22.2% in Group I, 22.9% in Group II, 1.2% in Group III, and 3.7% in Group IV. 2. In Group I, there was a close relationship between the mechanism of angina and the type of occurrence of typical chest pain; coronary artery spasm was more likely observed in rest angina, organic stenosis was observed in effort angina, and the combined type was observed in cases with both spasm and organic stenosis. Furthermore, the occurrence of coronary artery spasm was significantly more frequent in cases with single vessel disease compared with those with multivessel disease (50.7% vs. 26.7%, p less than 0.005). 3. In Group II, the most frequent angiographic evidence was fixed organic stenosis, and there was no relationship between spasm and the numbers of diseased vessels. 4. In Groups III and IV, the most common entity causing coronary artery spasm was hypertrophic cardiomyopathy. In conclusion, two major mechanisms of angina pectoris, i.e., coronary artery spasm and organic stenosis, are closely related to the symptomatology of this disease, such as rest, effort and combined rest and effort types.