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Unimproved chest pain in patients with minimal or no coronary disease: a behavioral phenomenon
Insights
Patients with minimal coronary disease often experience persistent chest pain. A high hypochondriasis score, indicating exaggerated health concerns, was the strongest predictor of ongoing chest pain in these individuals.
Area of Science:
- Cardiology
- Psychosomatic Medicine
Background:
- Patients with chest pain and minimal or no coronary artery disease (CAD) generally have a good survival prognosis.
- Despite this, a significant number continue to experience persistent chest pain, impacting their quality of life.
Purpose of the Study:
- To identify predictors of persistent chest pain in patients with minimal or no obstructive CAD.
- To investigate the association between psychological factors and ongoing chest pain in this patient group.
Main Methods:
- Analysis of clinical history and cardiac catheterization data from 821 medically treated patients.
- Stepwise logistic regression was used to identify significant predictors of unimproved chest pain.
- Inclusion of behavioral variables, including the Minnesota Multiphasic Personality Inventory (MMPI) hypochondriasis scale, in a subset of 217 patients.
Main Results:
- Low rates of cardiac death (0.3%) and myocardial infarction (0.2%) were observed in the first year post-angiography.
- Female sex and specific chest pain descriptors were associated with unimproved pain.
- A high hypochondriasis score emerged as the strongest predictor (p < 0.0001) of continued chest pain.
Conclusions:
- Persistent chest pain in patients with minimal/non-obstructive CAD is not associated with poor cardiac outcomes.
- Psychological factors, particularly hypochondriasis, play a significant role in the experience of ongoing chest pain.
- Exaggerated preoccupation with personal health is prospectively linked to continued chest pain in this population.
Abstract:
Patients with chest pain and minimal or no coronary disease have a good prognosis for survival, yet many continue to have pain. In our experience with 821 medically treated patients there were three cardiac deaths (0.3%) and two nonfatal myocardial infarctions (0.2%) in the first year after angiography, which had revealed insignificant (less than 75% narrowing of the luminal diameter) or no coronary artery stenosis. In a subset of 548 patients selected with no apparent systematic difference from the inception cohort of 821 patients, there was complete absence of chest pain in 178 (33%) patients but 155 (28%) had similar or worse pain. From an analysis of clinical history and catheterization data entered in a stepwise logistic regression function, unimproved chest pain was significantly associated with female sex (p = 0.01) and an index of five chest pain descriptors (p = 0.0005). After adding selected behavioral variables available for a representative sample of 217 patients, a high hypochondriasis score (scale I from the Minnesota Multiphasic Personality Inventory) became the strongest determinant of continued pain (p less than 0.0001). In our experience, an exaggerated preoccupation with personal health is prospectively associated with continued chest pain in patients with minimal or no coronary disease.