Clinical course of isolated stable angina due to coronary heart disease.
OBJECTIVE
To describe the clinical course of patients with stable angina due to coronary heart disease without a history of cardiovascular (CV) events or revascularization (isolated angina).


RESULTS
Of 7,665 patients in a trial comparing long-acting nifedipine with placebo, 2170 (28%) had isolated angina. During a mean follow-up of 4.9 years, 147 of these died (1.4/100 patient-years), while 761 (8.7/100 patient-years) either died, or had a cardiac event or procedure. The first event was death in 82, myocardial infarction or heart failure in 112, coronary revascularization in 171, and chest pain requiring hospitalization in 396. Six hundred and twelve patients (6.8/100 patient-years) underwent coronary angiography (CAG), followed by revascularization in 371. Sixty-eight of 262 deaths or major cardiac events were preceded by chest pain requiring hospitalization or revascularization. Event-rates after CAG were higher than before. The stroke rate was 0.7/100 patient-years (75 patients).


CONCLUSIONS
Patients with stable isolated angina have low rates of death and major cardiac events, but relatively high rates of chest pain requiring hospitalization despite contemporary management. Since the majority of deaths and major CV clinical events are not preceded by clear warning symptoms, the main clinical implication is that measures to prevent such events must target all patients.
Poole-Wilson
Philip A
PA
Cardiac Medicine, National Heart and Lung Institute, Imperial College London, London, UK. nicolucci@negrisud.it
Vokó
Zoltán
Z
Kirwan
Bridget-Anne
BA
de Brouwer
Sophie
S
Dunselman
Peter H J M
PH
Lubsen
Jacobus
J
D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D017023:Coronary Angiography / Q000379:methods; D003327:Coronary Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000379:methods; D020521:Stroke / Q000401:mortality / Q000517:prevention & control