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 studies2 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.
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