為探討變異型心絞痛病患其臨床和實驗檢查的特徵及其預後，我們篩選於本院執行心導 管檢查的連續1,329位急性冠心病病患，回溯分析變異型心絞痛病患併冠狀動脈攝影為正常或 幾近正常之病歷記錄及冠狀動脈攝影資料。這十年來共14位病患為變異型心絞痛病患併冠狀 動脈攝影為正常或幾近正常。其平均年齡為52歲；10位為男性而其中9位有抽煙。除了一位 病患外，大多數病患胸痛發生在半夜及早上。12位在住院第二天早上有抽血者，其高敏感度 C-反應蛋白質數據者其平均為5.5 mg/L。心電圖均呈現一過性ST波段升高，其中前壁導程有 8位、下壁導程有3位、同時前及下壁導程有3位。這些病例中以左前降枝冠狀動脈痙攣最常 見。於變異型心絞痛發生時，3位病患同時產生心房震顫，2位病患同時產生房室傳導阻滯。 在中位數54個月的追蹤中，無病患死亡、心肌梗塞、或復發變異型心絞痛。於追蹤期間有5 位病患因未戒煙或不規則服藥而有心絞痛發生。百分之一的急性冠心病病患為變異型心絞痛 併冠狀動脈攝影為正常或幾近正常。變異型心絞痛併冠狀動脈攝影為正常或幾近正常佔ST波 段升高急性冠心病的2%。這些病人的預後是好的。

To determine clinical and laboratory characteristics and prognosis of consecutive Taiwanese patients presenting with variant angina and normal or near-normal coronary arteries. A total of 1,329 consecutive patients with acute coronary syndrome who underwent coronary angiography at out hospital were retrospectively screened and reviewed. Over a 10-year period at our hospital, variant angina developed in 14 patients who had normal or near-normal coronary arteries. Of the 14 patients included in the study, mean age 52 years, 10 patients were men and 9 of the 10 men were cigarette smokers. All but one patient developed chest pain between midnight and morning. Twelve patients whose blood tests for high-sensitivity C-reactive protein on the second day after admission had a mean level of 5.5 mg/L. The electrocardiographic location of transient ST-segment elevation was in the anterior leads in 8 patients, inferior leads in 3 and both anterior and inferior leads in 3. Spasm of left anterior descending artery was the most common finding in these cases. Three patients developed atrial fibrillation and 2 patients had atrioventricular block during variant angina. During a median follow-up period of 54 months, no patient expired, suffered a nonfatal infarction, or recurrent variant angina. One percent of patients with acute coronary syndrome had variant angina with normal or near-normal coronary arteries. The variant angina with normal or near-normal coronary arteries could be found in 2% of the patients with ST-segment elevation acute coronary syndrome. These patients had a good prognosis. ( J lntern Med Taiwan 2010; 21: 79-89 )