First report of the successful use of bosentan in refractory vasospastic angina.

Variant angina is caused by focal spasm of the epicardial coronary arteries and is variably associated with atherosclerotic coronary disease. We present the clinical course of profound coronary spasm in a woman which resulted in life-threatening symptoms. Although not previously reported, administration of the endothelin antagonist bosentan resulted in complete resolution of her symptoms which were refractory to commonly used anti-anginals, and these symptoms recurred when the drug was inadvertently withdrawn, confirming efficacy of the agent. The details of her clinical outcome and a review of the role of endothelin and its antagonists in coronary vasospasm are discussed.