LONG-TERM FOLLOW-UP OF PATIENTS WITH ANGINA-LIKE CHEST PAIN AND NORMAL CORONARY ANGIOGRAMS

To determine the long-term prognosis of patients (pts) with angina-like chest pain and normal coronary arteriograms, 178 pts (61 women, 117 men; mean age 48.1 years) were followed for an average of 9.8 years (5.5-13.1 years). Eight pts (4.5%) died during follow-up: One pt from acute myocardial infarction, one pt suddenly, one pt from chronic cor pulmonale and 5 pts from non-cardiac diseases. Chest pain remained constant in 137/170 surviving pts (80.6 %), but disappeared in 33 pts (19.4 %). Nine of the 178 pts (5.1 %) developed manifest coronary artery disease (CAD): four of them (2.2 %) acute myocardial infarctions including one death, after an average of 7.2 years; in five pts (2.8 %) with continued chest pain a second coronary angiogram showed typical CAD. These pts with manifest CAD averaged 2.1 risk factors: six pts were smokers, two pts had elevated cholesterol levels (> 7.5 mmol/l), three pts had elevated triglyceride levels (> 2.4 mmol/l), two pts had a diabetes mellitus type IIa and six pts were hypertensives. Patients without manifestation of CAD averaged only 1.4 risk factors (p < 0.05). Our data show that pts with angina-like chest pain and normal coronary angiograms have an excellent long-term prognosis (only 0.51 % of patients with new manifestations of CAD per year). However, angina-like chest pain can persist over many years.