Variant angina identifies angina at rest with transient ST elevation (ASTE) caused by coronary vasospasm in patients with non-significant coronary stenosis (<70%) and also in those with significant coronary stenosis (⩾70%).^1–4 In those with significant coronary stenosis, however, it is often uncertain whether angina is due to vasospasm, increased vasoconstrictive reactivity¹ or intermittent formation of platelet aggregates on an acutely complicated plaque, or a combination. Patients with ASTE may develop serious cardiac events such as myocardial infarction or sudden death,^2–5 and although there are several series with follow-up^2–4 only in one was it >6 years.² Thus, we analysed the long-term prognostic markers in patients with ASTE with emphasis on potential sex differences.

METHODS

Consecutive patients with ASTE (n = 364) from January 1984 to December 1999 were included. ASTE diagnosis was based on ⩾1 episodes of ASTE (⩾1 mm) without enzyme increase. Exclusion criteria were age >70 years, left bundle branch block, associated cardiac disease, previous myocardial infarction or coronary revascularisation. Severe coronary vasospasm was documented when ergonovine or intracoronary acetylcholine was given intravenously in patients with <70% stenosis. Cardiac death, myocardial infarction and sudden death were identified as main events; cardiac death was considered when following heart failure, myocardial infarction or coronary revascularisation, and sudden death when it occurred within 1 h of symptom onset. Analysis of variance or Wilcoxon rank …