Patients with typical angina or anginalike chest pain and normal coronary angiograms had an 8% rate of coronary events over a median 12.4 years, with events linked to elevated risk factors.
Cohort (n=176)
Patients with anginalike chest pain and normal coronary angiograms have a favorable long-term prognosis, with coronary events occurring at a low rate (0.65%/year) and predominantly in those with elevated traditional risk factors.
OBJECTIVES: This study analyzes the long-term course of patients with typical angina pectoris or anginalike chest pain and normal coronary angiographic findings. BACKGROUND: In previous studies of such patients the rate of occurrence of typical coronary events during follow-up has differed widely, depending on the duration of the study and the number of patients. METHODS: One hundred seventy-six patients (mean age 48.3 years) who underwent coronary and left ventricular angiography for typical angina or anginalike chest pain were followed up for 5.8 to 15.8 years (median 12.4). By definition, all patients had normal findings on coronary and left ventricular angiograms; exercise test results were positive in 31. RESULTS: Fourteen patients (8%) had a coronary event (0.65%/year) after an average of 9.3 years (median 9.2). Two of the 14 died of a coronary event (0.09%/year), 1 of cardiogenic shock during acute myocardial infarction, 1 suddenly; 4 had a nonfatal myocardial infarction at an average of 8.1 years (median 9.1); 8 had severe angina pectoris after an average of 10.3 years (median 11.1), confirmed by a second angiogram, now with positive findings. Two patients died of a noncoronary cardiac event (chronic cor pulmonale due to obstructive lung disease, acute pulmonary embolism), eight of a noncardiac cause, mainly cancer. None of the 31 patients with a positive exercise test result had a coronary event. Patients with a coronary event had significantly more risk factors (hypercholesterolemia, hypertension, cigarette smoking, diabetes type II) than did those without an event (average 2.4/patient vs. 1.3/patient, p < 0.01). Chest pain persisted in 133 (81%) of the 164 survivors and disappeared in 31 (19%). CONCLUSIONS: Patients with typical angina or anginalike chest pain and normal coronary angiograms have a good long-term prognosis despite persistence of pain for many years; coronary morbidity and mortality are similar to those of the overall population. An increased risk for the development of coronary events is present mainly in patients with elevated risk factors.
Lichtlen et al. (Sat,) conducted a cohort in anginalike chest pain and normal coronary angiographic findings (n=176). Typical angina or anginalike chest pain with normal coronary angiograms was evaluated on Coronary event. Patients with typical angina or anginalike chest pain and normal coronary angiograms had an 8% rate of coronary events over a median 12.4 years, with events linked to elevated risk factors.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: