Mortality in patients with microvascular disease

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.