Suspected coronary artery disease and myocardial infarction with normal coronary angiography: a heterogeneous but benign condition?

• Autor(a) principal: Moreira, Nádia
• Data de Publicação: 2013
• Outros Autores: Ferreira, Maria João Vidigal, Soares, Francisco, Santos, Beatriz, Miranda, Ana, Gonçalves, Lino, Providência, Luís
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://hdl.handle.net/10316/102708; https://doi.org/10.1016/j.repc.2012.08.010
• topic: Myocardial ischemia; Coronary angiography; Prognosis; Isquémia miocárdica; Angiografia coronária; Prognóstico; Aged; Coronary Angiography; Coronary Artery Disease; False Negative Reactions; Female; Follow-Up Studies; Humans; Longitudinal Studies; Male; Middle Aged; Myocardial Infarction; Retrospective Studies

Introduction: Previous follow-up studies of patients with symptoms and/or non-invasive tests suggestive of ischemia or an acute coronary syndrome and a normal coronary angiogram have reported a good prognosis. Objectives: The aim of this study was to evaluate the clinical characteristics and outcome of a cohort of patients with suspected ischemic heart disease and normal coronary arteries. Methods: A clinical follow-up was performed of 607 patients (mean age 62 ± 11 years) with symptoms or non-invasive tests suggestive of ischemia (544) or myocardial infarction (63) and normal coronary angiography. The occurrence of major cardiac events or of readmission due to chest pain was recorded during a mean follow-up of 33.6 ± 9.5 months after angiography. Results: Patients with myocardial infarction were older (65.4 ± 11.1 vs. 61.9 ± 10.7, p=0.05), and the majority were women (68.3%). Hypertension was reported by 65.5% of patients, diabetes by 17.9%, dyslipidemia by 58.6%, smoking by 14% and family history of coronary artery disease in 11%. During follow-up no patient died from cardiovascular causes; three patients (0.5%) suffered myocardial infarction and 50 (8.3%) had recurrent chest pain leading to emergency admission. Patients with myocardial infarction had more events (20.6%) than those referred for angiography due to symptoms and/or positive non-invasive tests for ischemia (7.4%) (log-rank chi-square test: 13.6, p<0.0005). Conclusion: The incidence of risk factors was high. Our data suggest that patients with a normal angiogram had a good prognosis in spite of their baseline clinical presentation. A significant number of patients showed persistence of symptoms.