Long-term clinical course of patients with normal coronary arteriography: Follow-up study of 121 patients with normal or nearly normal coronary arteriograms

Isner, Jeffrey M.; Salem, Deeb N.; Banas, John S.; Levine, Herbert J.

doi:10.1016/0002-8703(81)90088-0

Cited by 114 publications

(37 citation statements)

References 32 publications

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“…Aside from the angina symptoms, the overall acute CV event rate during the 6 year follow-up was low, which support the current perception that patients with non-obstructive coronary disease have good prognosis [22,28]. But the prevalence of acute events in our group seem to be higher than the respective rates in the general population in Italy, being 2.2% for myocardial infarction and 1.4% for stroke [29].…”

Section: Data Interpretationsupporting

confidence: 82%

“…While 20% of our patients fell in this category, a significant higher percentage has been reported by others, even at shorter follow-up [14,22]. This raises the question about the nature of the angina like chest pain that patients complain of, which could be explained by either calcified epicardial vessels or microcirculation disease [4,[23][24][25][26] or else non-cardiac in origin, e.g.…”

Section: Data Interpretationmentioning

confidence: 50%

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Angina in Patients with Non-obstructive Coronary Angiograms: Six-years Follow-up

Vancheri

Milino

Henein

et al. 2017

ICFJ

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Background and Aim: About one third of patients undergoing coronary angiography for angina have non-obstructive coronary artery disease (CAD). Until recent years the prognosis has been thought to be favourable and no treatment were recommended. More recently, an increased risk of cardiovascular (CV) events has been documented in these patients compared with a general population. We aimed to evaluate the long term persistence of angina and the occurrence of major CV events in patients with stable angina and non-obstructive CAD.Methods: We retrospectively evaluated all patients with effort angina referred to the cardiac catheterization laboratory of the Cardiovascular Unit, University of Catania, Sicily, between 1st July 2008 and 31st December 2009, because of a clinical suspicion of myocardial ischemia, without obstructive CAD, defined as <50% stenosis of left main stem or <70% in any epicardial coronary artery.Results: Among 2574 patients (2025 men and 549 women) referred for diagnostic coronary angiography, 151 (5.8%) had non-obstructive coronary angiograms. Six-years follow-up was available in 127 patients (63 men and 64 women). Persistence of angina was reported in 20.4%. Four patients (3.1%) had acute myocardial infarction and two (1.6%) had stroke.Conclusion: During a six-years follow-up, persistence of angina and occurrence of acute major CV events were found in a significant proportion of patients with stable angina and non-obstructive coronary angiograms.

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Section: Data Interpretationsupporting

confidence: 82%

Section: Data Interpretationmentioning

confidence: 50%

Angina in Patients with Non-obstructive Coronary Angiograms: Six-years Follow-up

Vancheri

Milino

Henein

et al. 2017

ICFJ

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“…28 Results of such studies have been interpreted as "false positives" at one extreme and as indicative of myocardial ischemia of uncertain cause at the other. The most compelling argument against the presence of myocardial ischemia is that the prognosis of patients with chest pain and angiographically normal epicardial coronary arteries is believed to be benign,'0 13-15 29-31 even if they continue to experience frequent and disabling chest pain.30 31 We recently found that many patients with chest pain who have angiographically normal coronary arteries and no evidence of large vessel spasm after ergonovine challenge demonstrate a limited capacity to decrease coronary resistance and increase coronary flow in response to atrial pacing. 32 This apparent inappropriate vasodilator reserve was associated with the patient's typical chest pain and diminished lactate consumption.…”

mentioning

confidence: 99%

Left ventricular dysfunction in patients with angina pectoris, normal epicardial coronary arteries, and abnormal vasodilator reserve.

et al. 1985

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Thirty-three patients with chest pain despite angiographically normal coronary arteries underwent both coronary flow studies during pacing and resting and exercise gated blood pool scintigraphy. During atrial pacing after administration of ergonovine, those patients developing their typical chest pain demonstrated significantly lower great cardiac vein flow (97 ± 31 vs 150 + 33 ml/ min, p < .001), higher coronary resistance (1.27 -+-0.43 vs 0.77 ± 0.18 mm Hg/ml/min, p < .005), and less lactate consumption (30.5 ± 22.0 vs 69.7 + 41.1 mM * ml/min, p < .005) and a higher left ventricular end-diastolic pressure after pacing (20 + 4 vs 12 ± 1, p < .001) compared with those without pain and in the absence of significant luminal narrowing of the epicardial coronary arteries. The 26 patients with abnormal vasodilator reserve demonstrated reduced left ventricular ejection fraction during exercise (58 ± 8%) compared with the seveni patients with appropriate vasodilator reserve (66 ± 4%, p < .05) and with a group of 52 control patients of similar age and sex distribution and free of known heart disease (66 ± 10%, p < .001). In addition, 12 of the 26 patients with abnormal vasodilator reserve demonstrated exercise-induced regional wall motion abnormalities. Many of these patients also manifested impaired left ventricular diastolic filling at rest compared with the control subjects (peak filling rate 2.6 + 0.7 vs 3.2 -+ 0.7 end-diastolic volume/sec, p < .005). Thus, patients with chest pain resulting from abnormal vasodilator reserve demonstrate abnormalities of left ventricular systolic and diastolic function suggestive of myocardial ischemia. Circulation 71, No. 2, 218-226, 1985. MUCH DEBATE has focused on whether or not patients with chest pain despite normal epicardial coronary arteries truly experience myocardial ischemia. I6 Several investigators have found that many of these patients clearly have a noncardiac cause of their pain, including esophageal,7 8 chest wall,9 and psychosomatic causes.'0 However, others have found many such patients to have abnormal exercise electrocardiograms, 11-18,

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“…Marchandise et al [13] reexamined 22 patients after a mean interval of 4.5 years and did not ob serve the development of lesions. In the study of Proudfit et al [4], during a follow up period of 10 years, 10 of 357 patients underwent for clinical reasons a control cor- All patients included in the present study had angiographically completely normal cor onary arteries and no patients with minimal coronary lesions, as was the case in some previous studies [4,5,10], were included. The chest pain syndrome had been consid ered by the referring cardiologist as compat ible with pain of ischemic origin.…”

Section: Discussionmentioning

confidence: 89%

“…The incidence of coronary artery lesions on follow-up coronary arteriography is low in patients with normal coronary arteries and chest pain [4,10,11,13]. Marchandise et al [13] reexamined 22 patients after a mean interval of 4.5 years and did not ob serve the development of lesions.…”

Section: Discussionmentioning

confidence: 99%

Unexplained Chest Pain with Normal Coronary Arteriograms

Dorpe¹,

Piessens²,

Willems

et al. 1987

Cardiology

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One hundred and forty-two consecutive patients with unexplained chest pain and normal coronary arteries were followed up for a mean period of 49.3 ± 13.1 months. No cardiac deaths and one myocardial infarction occurred. Half of the patients were pain-free at follow-up. A definite relationship between persistence of pain and duration of pain history and a positive response to nitroglycerin before coronary arteriography were found. Patients with persistent pain were more frequently hospitalized for noncardiac diseases, underwent more surgical interventions and took more often noncardiac medication. Rehospitalizations for acute chest pain were infrequent. Two thirds of the patients resumed their normal activities. Younger age, disappearance of pain, type of occupation, and a shorter duration of the pain history favored return to work. Nonactive patients presented more intercurrent noncardiac, medical and surgical pathology. The findings in patients with a previous myocardial infarction were similar to those of the group with only chest pain.

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Long-term clinical course of patients with normal coronary arteriography: Follow-up study of 121 patients with normal or nearly normal coronary arteriograms

Cited by 114 publications

References 32 publications

Angina in Patients with Non-obstructive Coronary Angiograms: Six-years Follow-up

Angina in Patients with Non-obstructive Coronary Angiograms: Six-years Follow-up

Left ventricular dysfunction in patients with angina pectoris, normal epicardial coronary arteries, and abnormal vasodilator reserve.

Unexplained Chest Pain with Normal Coronary Arteriograms

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