The short and long-term efficacy of diltiazem for the treatment of variant angina pectoris.

We studied 42 consecutive patients with coronary artery spasm (CS) who where treated with the Ca2+ entry blocker diltiazem for a mean period of 11 months (range 2-29 months). Patient population consisted of 26 females (age X = 52.1) and 16 males (age X = 59.1). ALl patients had diagnosis of CS confirmed by coronary arteriography (CA) with no patient having 70 per cent CAD. CS was equally distributed between LAD and RCA. 81 per cent of patients were cigarette smokers, 55 per cent had Raynaud's phenomenon, and 9 per cent had a history of migraine, 2 patients had previous MI, 2 previous bypass surgery (CABS), 1 previous angioplasty, 3 syncope with heartblock requiring pacemaker, and 2 with sudden death (VF-resuscitated). All patients were placed on diltiazem 240 or 360 mg/day to achieve pain free state. During follow-up there was no mortality. 2 patients hd uncomplicated inferior MI's. 1 patient had CABS for progressive 90 per cent LAD lesion, and 2 required hospitalization for dose adjustment due to frequent chest pain. No patient has drug-related side effects. Thus, long-term follow-up of patients with CS treated with diltiazem revealed no mortality, low morbidity (12 per cent) and no adverse drug side effects.