[Comparison of clinical status and long-term outcome of patients with angina pectoris and normal coronary vessels in coronary angiography or insignificantly narrowed coronary arteries]

Abstract

Among patients investigated with coronary angiography because of effort chest pains, 8-30% are found to have insignificantly narrowed coronary arteries. In this group there are patients with angiographically normal coronary arteries and patients with hemodynamically insignificant atherosclerotic plaques. The aim of this study was to compare clinical status and long-term outcome of patients with effort angina whose epicardial coronary arteries were angiographically normal (Group 1) and patients with luminal diameter stenoses of maximum 30% (Group 2). Between III'91 and IV'97 we identified 230 patients who underwent coronary angiography in the Department of Coronary Artery Disease in Cracow. At the end of the follow-up the patients were asked to complete the self-report questionnaires which evaluated the course of the disease after discharge from the Department and present symptoms. On the basis of the medical records from the hospitalization in the Department and returned questionnaires data of 142 patients (Group 1: 89 patients, 46 men and 43 women, mean age 48.10 +/- 9.2 years; Group 2: 53 patients, 36 men and 17 women, mean age 52.51 +/- 9.6 years) were analyzed. Group 2 patients were older (p = 0.007), with higher prevalence of men (p = 0.05). The mean follow-up was 3.47 +/- 1.7 years for Group 1 and 2.85 +/- 1.7 years for group 2 (p = NS). Left ventricle contractility was normal in both groups. The occurrence of atherosclerosis risk factors was more frequent in Group 2 patients and didn't change significantly over the observation period. There were no deaths or new myocardial infarctions during the observation. Unstable angina occurred in 4 (2.8%) of patients. 33 patients (23.2%) reported hospital treatment for chest pain with mean frequency 0.13 +/- 0.3 hospitalizations/year in Group 1 and 0.09 +/- 0.17 in Group 2 (p = NS). Before coronary angiography this index was significantly higher -0.57 +/- 0.8 hospitalizations/year in group 1 and 0.51 +/- 0.7 in group 2 (p < 0.001 for both groups). Anginal symptoms improved significantly over the observation period. Before coronary angiography majority of patients (60.5% Group 1 patients and 58.3% of Group 2 patients) defined their angina as severe comparing to respectively 7.1% and 2.1% of patients at the end of follow-up (p < 0.05 for both groups). Only 8 (5.6%) of patients remained entirely asymptomatic at the end of the study. During the observation 7 (4.9%) of patients returned to work while 30 (21.1%) of patients retired for medical reasons out of which 25 (17.6%) were due to heart disease. During the follow-up there were no differences between the groups in the professional activity of patients. Group 2 patients were receiving more cardiac medications (mean 2.63 +/- 0.8 vs 2.18 +/- 0.9 at the discharge from the Department; p. = 0.05 and mean 2.52 +/- 0.9 vs 2.02 +/- 1.0 at the end of follow-up; p = 0.04). Group 2 patients were more frequently taking nitrates (86.3% vs 53.7% at the discharge from the Department; p < 0.001 and 77.1% vs 60.9% at the end of the study; p = 0.05) and diuretics.

Conclusions: 1. During follow-up (mean 3.4 years) there were no differences between the groups in the presence of symptoms, frequency of hospitalizations and occurrence of acute coronary events. 2. In both groups severity of anginal symptoms and frequency of hospitalizations decreased significantly. 3. The persistence of cardiac symptoms might have been caused by the presence of atherosclerosis risk factors during the follow-up.