Mild stenosis makes prognosis of vasospastic angina worse

OBJECTIVE Several studies have shown that significant coronary narrowing makes the prognosis of vasospastic angina pectoris (VAP) worse. However, the effects of various factors on the prognosis of patients without significant arterial narrowing have not yet been shown. METHODS AND RESULTS We investigated 1248 consecutive patients with VAP who had no coronary stenosis of more than or equal to 50%. The mean follow-up was 11.7±6.8 years. Ninety-one patients (7.3%) developed unstable angina, acute myocardial infarction, or effort angina with new coronary narrowings. Thirty patients (2.4%) died suddenly. Multivariate analysis showed that the presence of coronary stenosis, even if trivial, made the prognosis worse (P=0.027; odds ratio, 1.66; 95% confidence interval, 1.06-2.61). In addition, unusually, female patients had a better prognosis than male patients (P=0.007; odds ratio, 0.35; 95% confidence interval, 0.16-0.75). Other factors, such as hyperlipemia, diabetes, and hypertension did not affect the prognosis. CONCLUSION In patients with VAP, the presence of coronary narrowing, even if mild, was associated with worse prognosis.