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

Abstract

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.

Introduc¸ão: Estudos prévios de seguimento de doentes com sintomas e/ou testes não invasivos sugestivos de isquemia ou com síndrome coronária aguda e coronariografia normal têm revelado um bom prognóstico. Objetivos: Avaliar as características clínicas e o resultado de um grupo de doentes com suspeita de doenc¸a cardíaca isquémica e coronariografia normal. Métodos: Seguimento clínico de 607 doentes (idade média 62 ± 11 anos) com sintomas e/ou testes não invasivos sugestivos de isquemia (544) ou enfarte agudo do miocárdio (EAM) (63) e coronariografia normal. Registou-se a ocorrência de eventos cardíacos major ou a readmissão por dor torácica durante um período médio de seguimento de 33,6 ± 9,5 meses após a angiografia. Resultados: Os doentes com EAM eram mais velhos (65,4 ± 11,1 versus 61,9 ± 10,7, p = 0,05) e a maioria mulheres (68,3%). 65,5% dos indivíduos tinham história de hipertensão, referiam diabetes 17,9%, dislipidemia 58,8%, tabagismo 14% e história familiar de doenc¸a coronária 11%. Durante o seguimento, nenhum doente morreu de causas cardiovasculares, 3 tiveram EAM (0,5%) e 50 tiveram recorrência de dor torácica causando readmissão no servic¸o de urgência (8,3%). Doentes com EAM tiveram mais eventos (20,6%) do que os referenciados para angiografia devido aos sintomas e/ou teste não invasivo positivo para isquemia (7,4%) (logrank chi-square = 13,6, p < 0,0005). Conclusão: A incidência de fatores de risco nesta populac¸ão é elevada. Os nossos resultados sugerem que doentes com coronariografia normal, independentemente da apresentac¸ão inicial, têm bom prognóstico. Um número significativo de doentes tem persistência dos sintomas.