The syndrome of variant angina culminating in acute myocardial infarction.

Ten patients 28-54 years old with recurrent attacks of variant angina (chest pain associated with transient ST-segment elevation) culminating in acute myocardial infarction were studied. Systemic blood pressure and heart rate remained unchanged or decreased during chest pain. Diagnosis of myocardial infarction was made on the basis of pathognomonic enzyme changes and T-wave inversions persisting for several weeks (seven patients) or development of Q waves (three patients). Complications were similar to the ones previously observed in conventional myocardial infarction. None of these patients died. Past history was characterized by absence of effort angina. Exercise stress testing after infarction was normal, and coronary arteriography revealed a spectrum of pathology, ranging from normal arteriograms to three-vessel disease. Intraaortic balloon pumping was ineffective in two patients, but subsequent coronary bypass surgery shortly after myocardial infarction was not followed by further attacks of chest pain. Follow-up of these patients revealed a benign course. Alcohol drinking and cigarette smoking appeared to be very prevalent in this group.