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Long-term clinical course of patients with angina and angiographically normal coronary arteries
W Voelker1, U Euchner, H Dittmann
1Department of Cardiology, Tuebingen University, Federal Republic of Germany.
Insights
Patients with angina and normal coronary arteries generally have a benign long-term cardiac event rate. However, chest pain often persists or worsens, with
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Angina with normal coronary arteries (ANOCA) presents a diagnostic challenge.
- Long-term outcomes and predictors of symptom persistence in ANOCA patients are not fully understood.
Purpose of the Study:
- To evaluate the long-term prognosis of patients with ANOCA.
- To identify predictors of symptom resolution or persistence in this cohort.
Main Methods:
- Retrospective follow-up of 103 consecutive ANOCA patients 6-11 years post-catheterization.
- Analysis of clinical data, exercise tests, and coronary arteriogram findings, including the 'slow-flow phenomenon'.
Main Results:
- The long-term cardiac event rate was low (3 deaths, 1 myocardial infarction).
- Chest pain diminished in 47% but persisted or worsened in 53% of patients.
- Initial clinical and invasive findings did not predict symptom persistence, except for the 'slow-flow phenomenon' which was associated with worse outcomes.
Conclusions:
- ANOCA patients have a favorable prognosis regarding major cardiac events.
- Symptom persistence is common and difficult to predict with standard initial evaluations.
- The 'slow-flow phenomenon' warrants further investigation as a potential predictor of persistent angina.
Abstract:
In 88 of 103 consecutive patients with angina and normal coronary arteries, follow-up data could be achieved 6-11 years (9.2 +/- 1.2 years) after diagnostic left heart catheterization. Three of these patients died during follow-up (two noncardiac deaths and one death with no identifiable etiology). One patient suffered a documented myocardial infarction. In 40 patients (47%) chest pain diminished, while symptoms were unchanged in 20 (24%) or even worse in 25 (29%). Resolution or persistence of chest pain could not be predicted either by the character of pain (typical vs. atypical), the presence of hypertension, a left bundle-branch block, a positive exercise electrocardiogram or pathological pulmonary artery pressures during exercise, documentation of myocardial bridges, local wall motion abnormalities, or a left ventricular end-diastolic pressure greater than or equal to 13 mmHg. However, continuing chest pain was significantly more common in patients who revealed a 'slow-flow phenomenon' at initial coronary arteriogram. Thus, in patients with angina and normal coronary arteries the long-term course regarding frequency of morbid cardiac events is benign. However, more than half of the patients reported chest pain to be similar or even worse than at catheterization. Most clinical and invasive results at initial evaluation had no predictive value for the persistence of symptoms. The impact of 'slow-flow' in coronary arteriography, which was a phenomenon almost exclusive to patients with constant or even worse chest pain at follow-up, should be evaluated in larger patient populations.