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Published on: October 22, 2014
Mortality in patients with microvascular disease
David S Marks1, Surrendra Gudapati, L M Prisant
1Department of Cardiovascular Medicine, Medical College of Wisconsin, 9200 West Wisconsin Avenue, FEC 5100, Milwaukee, WI 53226, USA. dmarks@mcw.edu
Insights
Patients with chest pain and normal coronary angiograms may have poor outcomes. Abnormal coronary flow reserve (CFR) in these patients is linked to higher mortality, highlighting CFR
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Patients with chest pain and normal coronary arteriography often have a presumed benign prognosis.
- Hypertension is a common comorbidity in this patient group, impacting early disease stages.
- The prognostic significance of abnormal coronary flow reserve (CFR) in this population remains unclear.
Purpose of the Study:
- To investigate the association between abnormal CFR and long-term morbidity and mortality.
- To determine if invasive CFR measures predict outcomes in patients with chest pain and normal coronary angiograms.
Main Methods:
- Longitudinal follow-up of 168 patients with chest pain/ischemic cardiac disease and normal coronary angiograms.
- Invasive measurement of coronary flow reserve (CFR).
- Ascertainment of mortality via the national death index and quality of life via standardized questionnaires over a mean of 8.5 years.
Main Results:
- Patients with abnormal CFR (n=60) had significantly higher mortality (20%) compared to those with normal CFR (n=108, 7%; p=0.016).
- Abnormal CFR did not predict long-term impairment in functional health status.
- Significant long-term morbidity was observed in surviving patients.
Conclusions:
- Invasive measurement of CFR is a valuable prognostic tool in patients presenting with chest pain and normal coronary angiograms.
- Abnormal CFR predicts increased mortality in this patient cohort.
- Despite normal angiograms, these patients experience significant long-term morbidity and mortality risks.
Abstract:
Patients with chest pain/ischemic cardiac disease and normal coronary arteriography are thought to have a benign prognosis despite diminished quality of life. Many patients with hypertension fall into this group, at least in the early stage of their disease. Whether abnormalities in coronary flow reserve in these patients are associated with increased morbidity and mortality is unknown. One hundred sixty-eight patients with chest pain/ischemic cardiac disease and normal coronary angiograms who underwent invasive measures of coronary flow reserve were followed longitudinally. Mortality and quality of life were ascertained by query of the national death index and telephone administration of standardized questionnaires. Patient follow-up occurred at a mean of 8.5 years. In the abnormal coronary flow reserve group, 12 deaths (20%) were documented in 60 patients compared with eight out of 108 patients (7%; p=0.016) with normal coronary flow reserve. Coronary flow reserve did not predict impairment in functional health status in long-term follow-up. Thus, invasive measures of coronary flow reserve in patients with chest pain/ischemic cardiac disease and normal coronary angiograms predicted increased mortality. Surviving patients with chest pain/ischemic cardiac disease and normal coronary angiograms have significant morbidity.
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