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Title: | Suspected coronary artery disease and myocardial infarction with normal coronary angiography: a heterogeneous but benign condition? | Authors: | Moreira, Nádia Ferreira, Maria João Vidigal Soares, Francisco Santos, Beatriz Miranda, Ana Gonçalves, Lino Providência, Luís |
Keywords: | Myocardial ischemia; Coronary angiography; Prognosis; Isquémia miocárdica; Angiografia coronária; Prognóstico | Issue Date: | Mar-2013 | Serial title, monograph or event: | Revista Portuguesa de Cardiologia | Volume: | 32 | Issue: | 3 | 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. |
URI: | https://hdl.handle.net/10316/102708 | ISSN: | 0870-2551 | DOI: | 10.1016/j.repc.2012.08.010 | Rights: | openAccess |
Appears in Collections: | FMUC Medicina - Artigos em Revistas Nacionais |
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