Incidence of spontaneous and provoked coronary spasms after percutaneous transluminal coronary angioplasty

We studied the incidence of spontaneous and ergonovine-induced coronary arterial spasm during repeat coronary angiography in 96 consecutive patients with single-vessel disease who had undergone successful angioplasty. Follow-up angiography was performed after a mean of 6 months (1–8 months). Sixty patients demonstrated no restenosis and in 36 patients restenoses (>50% restenosis) occurred. Spasms of the arteries at the site of dilatation were significantly ( P < 0.001) more frequent in patients with restenosis ( 18 36 ; 50%) than in patients without restenosis ( 4 60 ; 7%). Before angioplasty, no differences were found in the clinical characteristics between the two groups. Likewise, the morphologic results of angioplasty were identical. Despite long-term treatment with nifedipine (30–60 mg daily) and aspirin (0.5 g daily), 14 of 18 patients with restenosis and coronary spasm suffered from spontaneous angina, as compared to only 3 of 18 patients with restenosis without demonstrable spasm. Three of the 4 patients without restenosis but with detectable spasm were also symptomatic. Thus our findings suggest that spasm of the coronary arteries achieves some importance as a pathophysiological factor for recurrence following coronary angioplasty.