Endothelial dysfunction in women with normal coronary arteries predicted the development of coronary artery disease over >10 years (59.1% vs 0% in patients without dysfunction).
Cohort (n=42)
Does baseline endothelial dysfunction predict the future development of coronary artery disease in women with angina and normal coronary angiograms?
Endothelial dysfunction in women with angina and normal coronary arteries is a significant predictor of future atherosclerosis and persistent chest pain over a 10-year period, challenging the belief that this condition is totally benign.
Absolute Event Rate: 59.1% vs 0%
BACKGROUND: The prognosis for women with chest pain and angiographically normal coronary arteries is believed to be totally benign. Previous studies, however, did not account for the delay of a decade or so in the development of coronary artery disease that women may experience. METHODS AND RESULTS: This study assessed long-term follow-up of 42 women with de novo angina, evidence of reversible myocardial perfusion defects on SPECT, and normal coronary angiograms. At recruitment, all women underwent endothelial function testing (intracoronary acetylcholine) during catheterization. Patients were followed up for >10 years. Angiography was repeated at the end of the follow-up in 37 patients. At recruitment, 22 patients developed diffuse vasoconstriction during acetylcholine in the absence of identifiable focal coronary spasm (acetylcholine-positive group). The remaining 20 patients showed vasodilation (acetylcholine-negative group). At the end of follow-up, in the acetylcholine-positive group, 1 patient developed cardiac death, 13 still complained of chest pain, and 8 had remission of symptoms. In the acetylcholine-negative group, all patients showed complete resolution of chest pain beginning 6 to 36 months after baseline assessment. Angiography showed development of coronary artery disease in the 13 symptomatic patients in the acetylcholine-positive group. CONCLUSIONS: In women with angiographically normal-appearing coronary arteries, persistence of chest pain over the years often relates to development of coronary artery disease. Endothelial dysfunction in a setting of normal coronary arteries is a sign of future development of atherosclerosis.
Bugiardini et al. (2004) conducted a cohort in De novo angina with normal coronary angiograms (n=42). Endothelial dysfunction (acetylcholine-positive) vs. Normal endothelial function (acetylcholine-negative) was evaluated on Development of coronary artery disease. Endothelial dysfunction in women with normal coronary arteries predicted the development of coronary artery disease over >10 years (59.1% vs 0% in patients without dysfunction).