Key result
Patients with stable angina pectoris without obstructive CAD had a reduced risk of myocardial infarction compared to the general population (adjusted IRR 0.59; 95% CI 0.50-0.70).
Why the study?
Patients with stable angina pectoris without obstructive CAD by coronary angiography are presumed to have a continued high cardiovascular risk despite no CAD.
Do patients with stable angina pectoris but without obstructive coronary artery disease have a higher 10-year cardiovascular risk compared to the general population?
Cohort (n=110,878)
Do patients with stable angina pectoris but without obstructive coronary artery disease have a higher 10-year cardiovascular risk compared to the general population?
Patients with stable angina but no obstructive CAD on angiography have a significantly lower 10-year risk of MI, MACE, and death compared to the matched general population, challenging the presumption of continued high risk in this group.
Challenges presumption of elevated risk in stable angina without obstructive CAD; observational data leave open whether risk stratification should change.
Background Patients with stable angina pectoris who do not have obstructive coronary artery disease (CAD) by coronary angiography are presumed to have a continued high cardiovascular risk despite no CAD. Purpose We examined the 10-year risk of myocardial infarction (MI), major adverse cardiovascular events (MACE), and death in elective patients with stable angina pectoris, but without CAD by coronary angiography compared to an age and sex matched general population cohort from Western Denmark. Methods We performed a cohort study of patients with stable angina pectoris without obstructive CAD by elective CAG examined between 2003 and 2016 in Western Denmark. Patients were compared to an age and sex matched general population comparison cohort without previous MI or coronary revascularization. Outcomes were MI, MACE (a composite of MI, ischemic stroke, and cardiac death), and death. Maximum follow-up was 10 years. Adjusted incidence rate ratios (IRRs) were computed using conditional Poisson regression. We also did a stratified analysis by sex and levels of comorbidity. Results A total of 18,491 patients suspected of angina pectoris without obstructive CAD, and 92,387 individuals from the general population were included in the study. Median follow-up was 8.6 years. Patients with chest pain but without CAD had reduced risk of MI (adjusted IRR 0.59, 95% CI 0.50–0.70, Figure), MACE (adjusted IRR 0.64, 95% CI 0.57–0.80), and death (adjusted IRR 0.62, 95% CI 0.59–0.67) compared to the general population when adjusting for potential confounders. Results were consistent when stratifying by sex and levels of comorbidity. Conclusions Absence of angiographic obstructive CAD in patients with symptoms of stable angina pectoris was associated with favorable low 10-year cardiovascular risk and mortality compared to the general population without known coronary status. Figure 1 Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): Department of Cardiology, Aarhus University Hospital
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Olesen et al. (2020) conducted a cohort in Stable angina pectoris without obstructive coronary artery disease (n=110,878). Stable angina pectoris without obstructive CAD vs. Age and sex matched general population cohort without previous MI or coronary revascularization was evaluated on Myocardial infarction (MI) (IRR 0.59, 95% CI 0.50-0.70). Patients with stable angina pectoris without obstructive CAD had a reduced risk of myocardial infarction compared to the general population (adjusted IRR 0.59; 95% CI 0.50-0.70).
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