[Discussion on therapeutic attitude in Prinzmetal's angina. Apropos of 6 cases].

1. 46 cases of Prinzmetal's angina have been studied: there were 36 males and 10 females, with an average age of 54.6 years. 19 patients (group A) were treated medically, and 12 of these were followed up for more than 6 months (average follow-up period 45.1 months). 27 patients (group B) underwent a coronary by-pass procedure: 22 of these were followed up for more than 6 months after surgery (average postoperative follow-up period 21.6 months). 2. One patient from group A and two patients from group B died, one of them from postoperative renal failure. None of the three deaths could be attributed directly to the coronary artery disease. 2 patients from group A and 5 patients from group B had a myocardial infarction without fatal outcome. 5 of the 12 patients in group A and 16 of the 22 patients in group B were asymptomatic after more than 6 months of follow-up. 3. The treatment policy should take account: - of the prognosis of Prinzmetal's angina, which is on the whole better than that of an unstable angina pectoris of the common type; - of an assessment of the risks in each individual case; these are increased when there is a combination of risk factors for atherosclerosis, and/or severe arrhythmia with syncope, and/or persistant electrical changes in the territory of the anterior descending artery, and/or coronary artery lesions involving two or three major vessels. 4. Surgery is used if there is a failure of treatment with beta-blockers, which are used under cover of a pacemaker when there is a paroxysmal block. If medical treatment is successful, surgery is indicated in high-risk cases.