To investigate the changing aspect of the long-term prognosis of patients with medically-treated variant angina, we studied 253 consecutive patients treated from January 1963 to August 1984. The patients were categorized into two groups according to the year of first admission to our hospital; 88 patients hospitalized before January 1975 and mainly treated with nitrates (group I), and 165 patients admitted thereafter and treated with calcium antagonists (group II). The average follow-up period was 63.1 months (ranged from one to 136) in the group I, and 32.4 months (ranged from one to 116) in the group II. Coronary arteriography was performed in 146 patients of the group II. In 82 patients (56%), no fixed coronary artery stenosis of greater than or equal to 75% of the luminal diameter was present; 47 patients (32%) had one-vessel disease, and 17 (12%) had multi-vessel involvement. Seventy-eight patients having both rest and effort angina showed a higher prevalence of fixed coronary artery stenoses (50 of 78 patients) compared with the patients without effort angina (14 of 68 patients) (p less than 0.001). The group II showed a significantly good long-term efficacy of medical treatment for anginal attacks (124 of 165 patients compared with 54 of 88 group I patients: p less than 0.05). Complete remission over three months or more occurred in 56% of the group II compared with 45% of the group I. Fourteen patients (16%) of the group I suffered from myocardial infarction (10 were within six months of onset of angina); whereas, only five (3%) of the group II developed myocardial infarction (two were within six months of initial anginal attack) (p less than 0.001). Cardiac death occurred in five patients (6%) of the group I in contrast to four patients (2%) of the group II. The patients having significantly effective medical treatment for anginal attack were 80%, 62% and 64% in those without significant stenosis, with one-vessel disease, and with multi-vessel disease, respectively. Myocardial infarction occurred in two of 17 patients with multi-vessel disease. Spontaneous remission of angina over at least three years without medical treatment occurred in seven of 32 patients who were followed for more than 10 years. It was concluded that the long-term prognosis of patients with variant angina who received calcium antagonists was reasonably improved compared with patients treated with nitrates.(ABSTRACT TRUNCATED AT 400 WORDS)