title: [Long-term outcome in patients with angina-like chest pain and normal coronary angiograms].
abstract: BACKGROUND
  Short-term prognosis of patients with chest pain and angiographically smooth coronary arteries is good in terms of development of coronary events (fatal or nonfatal myocardial infarction, coronary death, new coronary heart disease), but long-term studies are rare.
  
  
  METHODS
  185 consecutive patients (mean age 54 +7.8 years, 59% male)with typical angina pectoris or atypical chest pain who underwent coronary angiography between 1980 and 1989 and had completely normal coronary arteries and left ventricular function (mean ejection fraction 68%) were followed over a period of 12.0 +/- 2.9 years. Exercise tests showed ischemia in 51 patients (ECG) and 21 patients (myocardial scintigraphy), respectively. 173 patients could be recruited for follow-up.
  
  
  RESULTS
  One patient died from acute myocardial infarction (0.05% per year). Nine patients died potentially from cardiac causes (0.51% per year) and seven from extracardial diseases. No nonfatal myocardial infarctions were documented. Six patients developed an angiographically documented coronary heart disease with significant stenoses after a mean follow-up of 12.7 years (0.3% per year). These patients had significantly more coronary risk factors than patients without coronary heart disease (2.8 vs. 1.8; p < 0.05) but not more often pathologic findings in rest-ECG (28% vs. 36%; not significant [n.s.]) and exercise test-ing (14% vs. 32%; n.s.). Frequency and intensity of chest pain remained unchanged in 34% of the patients. Symptoms regressed in more patients with an initially negative exercise test compared to patients who had a positive exercise test (78% vs. 54%;p < 0.05). The decrease in patients taking nitrates did not differ significantly between both groups (-42% vs. -27%; n.s.).
  
  
  CONCLUSIONS
  Patients suffering from angina-like chest pain with normal coronary angiograms have a good long-term prognosis which does not differ from the general population of the same age. Patients with positive stress tests will have less relief from their symptoms than patients with a negative stress test over many years.
authors.affiliation: Herz- und Kreislaufzentrum, Rotenburg an der Fulda, Germany. manfred.scholz@hkz-rotenburg.de
authors.forename: Manfred
authors.initials: M
authors.lastname: Scholz
authors.forename: Katlin
authors.initials: K
authors.lastname: Wegener
authors.forename: Martin
authors.initials: M
authors.lastname: Unverdorben
authors.forename: Harald
authors.initials: H
authors.lastname: Klepzig
mesh_terms: D000328:Adult; D000368:Aged; D004562:Electrocardiography; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D017566:Microvascular Angina / Q000175:diagnosis; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors