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Therapeutic and economic value of a normal coronary angiogram
Insights
Coronary arteriography in patients with severe chest pain reveals normal vessels, leading to improved symptoms and reduced hospitalizations. This diagnostic procedure offers significant therapeutic and economic benefits, enhancing patient outcomes and lowering healthcare costs.
Area of Science:
- Cardiology
- Diagnostic Imaging
Background:
- Many patients presenting with severe chest pain have normal coronary arteries.
- Coronary arteriography is often performed to investigate these symptoms.
Purpose of the Study:
- To evaluate the therapeutic and economic benefits of coronary arteriography in patients with normal coronary vessels presenting with severe chest pain.
Main Methods:
- Analysis of clinical status and hospitalizations for 72 patients with normal coronary arteries before and after coronary arteriography.
- Assessment of symptom reclassification, functional status (New York Heart Association class), medication use, employment, and healthcare facility utilization.
Main Results:
- Normal coronary arteriogram significantly altered symptom assessment, with fewer patients classified as having angina.
- 74% of patients showed functional improvement, and 50% had no functional limitation post-procedure.
- Significant reductions in cardiac medication use, hospital days (from 17 to 3.9), hospitalizations (from 1.5 to 0.4), and estimated hospital costs were observed.
Conclusions:
- Coronary arteriography in patients with severe chest pain and normal coronary arteries improves clinical assessment, functional status, and reduces medical therapy and healthcare utilization.
- The therapeutic and economic benefits warrant consideration in the overall evaluation of coronary angiography's effectiveness.
Abstract:
A significant number of patients with severe angina or intractable atypical chest pain referred for coronary arteriography are found to have normal coronary vessels. To determine what therapeutic or economic benefit may be derived from these studies, we analyzed the data of 72 consecutive patients with normal vessels referred for cardiac catheterization because of severe chest pain. The clinical status and hospitalizations were analyzed for the 2 year period before and the 2 year period after angiography. There were no deaths or myocardial infarctions. Although 47 were thought to have angina and 25 atypical pain before catheterization, the chest pain was reclassified with only 15 continuing to have anginal pain, 40 atypical pain, and 17 no pain. Functional improvement by at least one New York Heart Association class occurred in 74 percent of patients with 36 (50 percent) having no functional limitation. The use of cardiac medications was also significantly reduced. Despite functional improvement, no change in employment states could be demonstrated. The use of medical facilities was significantly less, the average number of hospital days per patient declining from 17 to 3.9 and hospitalization decreasing from 1.5 to 0.4. The result was a significant decrease in estimated hospital costs. We conclude that in patients referred for coronary angiography for severe chest pain, documentation of a normal coronary arteriogram significantly alters the clinical assessment of symptoms, improves functional status, modifies medical therapy, and reduces hospitalization and medical costs. These therapeutic and economic benefits deserve consideration in the evaluation of coronary angiography for its overall effectiveness.