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The syndrome of chest pain, abnormal stress test, and nonflow limiting coronary artery disease (CAD) is common and is attributed to coronary microvascular disease (?VD). It is associated with increased hospital admissions and health care costs. But its impact on long-term survival is not known. Of the 9941 consecutive patients who had an exercise stress test for evaluation of chest pain between May 1991 and July 2007, 935 had both a positive stress test and a coronary angiogram within 1?year of their stress test forming the study cohort. Significant angiographic CAD defined as ?70% stenosis of an epicardial coronary artery or ?50% stenosis of the left main coronary artery was present in 324 patients. Rest (n?=?611) were considered to have coronary ?VD. Compared with patients with significant epicardial CAD, patients with coronary ?VD were younger (63???11 vs. 65???10 years, p?=?0.002), and had lower left ventricular wall thickness (p?

Coronary artery bypass grafting (CABG) in patients with systolic heart failure (HF) carries high morbidity and mortality rates. Reducing perioperative mortality with beta-blockers (BBs) may help improve outcomes. Analysis of 4903 patients who underwent isolated CABG surgery was performed. In-hospital mortality of systolic HF patients who received BBs was 2.03%; systolic HF patients who did not receive BBs had a mortality of 5.20%. Thirty-day mortality was 2.98% in the patients with systolic HF who received BBs and 6.16% in the patients who did not. beta-Blockade did not affect the mortality in patients with preserved systolic function. Cardiogenic shock was a predictor of increased mortality in patients with systolic HF, while BBs reduced mortality. BBs are associated with decreased in-hospital and 30-day mortality in patients with systolic HF. BB therapy should be considered in patients with systolic HF who are undergoing CABG.

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