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- C. Richard Conti, MD∗ ( )()
- ↵∗Division of Cardiovascular Medicine, Department of Medicine, University of Florida College of Medicine, P.O. Box 100277, Gainesville, Florida 32610-0277
I read with interest the report by Takagi et al (1). I was very impressed by the amount of information they were able to gather about a topic that is not frequently seen by any individual practitioner. I congratulate the authors for trying to assess the risk of vasospastic angina by developing a risk score.
I have 1 concern regarding the risk score: the history of out-of-hospital cardiac arrest. Although I admit this is a risk for a future event, it is also an endpoint for a major adverse cardiac event, and I am not sure it belongs in the same category as smoking, angina at rest, organic coronary stenosis, multivessel spasm, ST-segment elevation during angina, and beta-blocker use.
I also noticed that the degree of an acute myocardial infarction did not seem to make any difference in terms of prognosis. Acute myocardial infarction is also an endpoint for a major adverse cardiac event.
The only other issue I have with this well-written, interesting article is that in the first paragraph, the authors seem to equate vasospastic angina with Prinzmetal angina or variant angina. I have no doubt that the cause of the problem for the majority of patients with Prinzmetal angina is coronary artery spasm, but not all ST-segment elevation is related to the spasm. In fact, Prinzmetal (2) described this syndrome before Mason Sones (3) wrote about his experience with selective coronary angiography.
Another point that I think is useful to understand is that this is a relatively recent experience with vasospastic angina, and thus these patients were probably exposed to contemporary aggressive medical management, including lipid reduction, blood pressure control, and aspirin therapy.
- American College of Cardiology Foundation