["Variant" angina: clinical, electrocardiographic and coronarographic aspects in 40 cases. Considerations for treatment (author's transl)].

Forty patients with chest pain and the electrocardiographic aspects of Prinzmetal's variant angina were studied by means of selective coronary arteriography. In 36 cases (90%) severe coronary lesions could be demonstrated: in 75% of the cases a critical obstruction involved a single major coronary trunk; only in 15% two or more vessels were affected. The vessel most frequently involved by critical obstruction was the left anterior descending (57%); in 5 cases (12.5%) a severe stenosis of the common left coronary trunk was present. In 8 cases critical stenosis were reduced by coronary dilators and were completely resolved in 2 cases. Peripheral lesions with multiple secondary branches involvement were present in none of the cases. A common finding was the absence of evident collateral anastomotic circulation. The comparison of the electrocardiographic manifestations of the anginal crisis and the angiographic findings showed a strict correlation between the area of subepicardial lesion and the major coronary vessel distributing to the corresponding myocardial region. Of the 40 patients, 17 were treated medically and 23 underwent a surgical aortocoronary bypass: the results (surgical mortality 22%; complete success 52%) are compared with those in the literature. Prognosis appears to be severe: coronary arteriography must be performed under criteria of urgency, and the possibilities of treatment must be considered on the basis of the angiographic findings.