A Controlled Trial of Verapamil for Prinzmetal's Variant Angina

To assess the efficacy and safety of verapamil in variant angina pectoris, we entered 16 patients in a double-blind, randomized trial of nine months' duration. During treatment with verapamil, the frequency of angina fell substantially (12.6±25.9 chest pains per week with placebo, 1.7±2.8 pains per week with verapamil, mean ±S.D.; P<0.01), as did the use of nitroglycerin tablets (14.4±34.4 tablets per week with placebo, 2.1 ±3.3 tablets per week with verapamil; P<0.05). The number of hospitalizations for clinical instability was significantly lower with verapamil (P<0.01). The number of episodes of transient ST-segment deviation during treatment with verapamil was reduced (33.1 ±39.3 ST-segment deviations per week with placebo, 7.7±11.7 deviations per week with verapamil; P<0.01). Verapamil caused no side effects forcing a reduction in dosage or a discontinuation. We conclude that verapamil is safe and effective in the therapy of variant angina pectoris. (N Engl J Med. 1981; 304:862–6.) IN 1959, Prinzmetal et al.¹ described a group of patients with chest pain at rest associated with transient ST-segment elevation and termed this syndrome “variant” angina pectoris. They hypothesized that this syndrome was due to coronary arterial spasm, and subsequent arteriographic studies^{2 3 4} have shown this hypothesis to be correct. More recent studies have shown that coronary arterial spasm may induce clinical events in patients with angina at rest⁵ or with acute myocardial infarction.⁶ Since spasm may be operative in many persons with ischemic heart disease, the identification of pharmacologic agents that are efficacious in the treatment of variant angina may.