Unexplained chest/epigastric pain in patients with normal endoscopy as a predictor for ischemic heart disease and mortality: a Danish 10-year cohort study.
BACKGROUND
Normal upper endoscopy may be a marker of ischemic heart disease in patients with unexplained chest/epigastric pain.


METHODS
We examined the 10-year risk of ischemic heart disease and mortality in a cohort of 386 Danish patients with chest/epigastric pain, normal upper endoscopy, and no prior hospital discharge diagnosis of ischemic heart disease (defined as patients with unexplained chest/epigastric pain), compared with 3,793 population controls matched by age, gender, and residence. Outcome data were obtained from population-based health registries. Cox regression analysis was used to estimate the relative risk of hospitalization for ischemic heart disease and the adjusted mortality rate ratio (MRR).


RESULTS
The 10-year relative risk of hospitalization for ischemic heart disease following a normal upper endoscopy among patients with unexplained chest/epigastric pain was 1.6 (95% CI, 1.1-2.2), compared with controls. The 10-year MRR was 1.1 (95% CI, 0.9-1.5). Within the first year after the upper endoscopy the MRR was 2.4 (95% CI, 1.3-4.5). The cause-specific MRR among patients with unexplained chest/epigastric pain compared with controls was up to threefold higher for deaths related to alcohol dependence, pneumonia, and lung cancer.


CONCLUSIONS
Unexplained chest/epigastric pain in patients with normal endoscopy is a strong marker for ischemic heart disease and increased mortality.
Munk
Estrid Muff
EM
Department of Clinical Epidemiology, Aarhus and Aalborg Hospital, Aarhus, University Hospital, DK-8000 Aarhus C, Denmark. emm@alm.au.dk
Nørgård
Bente
B
Dethlefsen
Claus
C
Gregersen
Hans
H
Drewes
Asbjørn Mohr
AM
Funch-Jensen
Peter
P
Sørensen
Henrik Toft
HT
D000328:Adult; D002637:Chest Pain / Q000175:diagnosis*; D015331:Cohort Studies; D003718:Denmark / Q000453:epidemiology; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000401:mortality* / Q000628:therapy*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012306:Risk; D041742:Upper Gastrointestinal Tract