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Abstract
This study analyzes the long-term course of patients with typical angina pectoris
or anginalike chest pain and normal coronary angiographic findings.
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.
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.
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%).
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.