What Is the First-Line Treatment of Variant Angina (Coronary Artery Spasm)?
Variant angina is caused by coronary artery spasm (CAS) and can manifest as both symptomatic angina attacks and clinically silent episodes of myocardial ischaemia. First-line treatment targets long-term prevention of spasm and aims to eliminate both event types.
Treatment Goals
Abolition or consistent decrease of angina attacks, and abolition of episodes of silent myocardial ischaemia detected by 24/48-h ECG Holter monitoring.
First-Line Approach
A specific class of vasodilatory agents forms the cornerstone of long-term prevention of coronary artery spasm. Both major pharmacological sub-types within this class have demonstrated efficacy. The complete agent selection, structured regimen, and full algorithm are available in the protocol below.
References
- Calcium channel blockers (CCBs) are the first-line treatment for coronary artery spasm (CAS).
- The non-specific arterial dilator CCBs form the cornerstone of treatment for the long-term prevention of CAS.
- Both dihydropyridine (DHP) and non-DHP drugs can be used.
- The efficacy of these drugs in preventing CAS, and therefore abolishing, or consistently decreasing, angina attacks, has been clearly demonstrated in several studies and is a common experience in clinical practice.
- Because most episodes of CAS-induced myocardial ischaemia are silent, treatment should ideally aim to abolish not only angina episodes, but also episodes of silent myocardial ischaemia detected by 24/48-h ECG Holter monitoring.
DOI: 10.15420/ecr.2022.47
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