Prinzmetal's variant form of angina pectoris. Re-evaluation of mechanisms.

Thirty-five patients with typical Prinzmetal's variant angina were studied by coronary cineangiography. There was no demonstrable stenosis of the major coronary arteries in 19 patients. Nine patients with single coronary stenosis underwent aortocoronary bypass and had recurrence of the symptoms postoperatively. Administration of nifedipine effected complete cessation of the symptoms among patients formerly treated medically. Although surgical treatment did not effect permanent relief of pain, all patients initially treated surgically experienced relief of pain when nifedipine was administered. The pathophysiology of variant angina remains obscure. Our results suggest that neurohumoral factors exert more of an effect on the myocardial cell than on the coronary vessels.