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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-up2–4 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.
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 …