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The prognosis for patients with new-onset angina who have undergone cardiac catheterization
Insights
New-onset angina in patients with known coronary artery disease indicates a higher risk of cardiac events, especially in those not undergoing surgery. Survival rates are similar between new-onset and chronic angina groups when treated surgically.
Area of Science:
- Cardiology
- Clinical Prognostics
Background:
- New-onset angina is a critical symptom in patients with coronary artery disease.
- Understanding its prognostic significance is vital for patient management.
Purpose of the Study:
- To investigate the prognostic value of new-onset angina in patients with known coronary anatomy.
- To compare outcomes between new-onset and chronic angina in different treatment settings.
Main Methods:
- Retrospective analysis of 1727 patients with significant coronary artery disease.
- Classification based on angina duration (new-onset < 3 months vs. chronic) and presence of preinfarction angina.
- Outcomes assessed included survival and cardiac events (myocardial infarction, death) at 1 year for surgically and non-surgically treated groups.
Main Results:
- New-onset angina patients showed a higher incidence of single-vessel disease and lower rates of triple-vessel and left main disease compared to chronic angina.
- In non-surgically treated patients without preinfarction angina, new-onset angina was associated with a significantly higher rate of cardiac events (16% vs. 7%) at 1 year.
- Survival and event-free rates were lower in patients with preinfarction angina compared to those without.
Conclusions:
- New-onset angina, particularly without preinfarction features, carries an increased risk of cardiac events in non-surgically treated patients.
- Surgical intervention appears to mitigate the differential risk associated with new-onset angina.
- Preinfarction angina is a strong negative prognostic indicator regardless of angina onset type.
Abstract:
We investigated the prognostic significance of new-onset angina in patients in whom coronary anatomic characteristics were known. New onset angina was defined as angina of less than 3 months duration. Consecutive patients (n = 1727) with significant coronary artery disease (diagnosed at cardiac catheterization) and who had not had a prior myocardial infarction or congestive heart failure were studied. In patients with new-onset angina (n = 329) there was a higher incidence of single-vessel disease (43% vs 27%) and a lower incidence of triple-vessel (23% vs 35%) and left main artery (5% vs 10%) disease compared with patients with chronic angina (n = 1398). Patients were classified by the presence or absence of preinfarction angina (severe and prolonged angina at rest requiring hospitalization to rule out myocardial infarction). In patients treated without surgery and who did not have preinfarction angina, survival at 1 year was 97% for patients with new-onset angina and 98% for those with chronic angina (p = .27). Among patients not treated surgically who did not have preinfarction angina, at 1 year 16% with new-onset angina and 7% with chronic angina had suffered a cardiac event (nonfatal myocardial infarction or death, p = .006). In patients treated surgically who did not have preinfarction angina, survival at 1 year was 96% both for those with new-onset angina and those with chronic angina (p = .99). The risk of an event in patients treated surgically at 1 year was not statistically different in patients with new-onset angina and those with chronic angina (12% vs 11%, p = .27). Survival and event-free rates were lower in patients with preinfarction angina than in patients who did not have it.(ABSTRACT TRUNCATED AT 250 WORDS)