A 14-year follow-up study of chest pain patients including stress hormones and mental stress at index event.
BACKGROUND
Knowledge of long-term outcome in chest pain patients is limited. We reinvestigated patients who 14 years earlier had visited the emergency department due to chest pain, and were discharged without hospitalization. Extensive examinations were made at that time on 484 patients including full medical history, exercise test, a battery of stress questions and stress hormone sampling.


METHODS
From a previously conducted chest pain study patients still alive after 14 years were approached. Hospitalization or deaths with a diagnosis of ischemic heart disease or cerebrovascular disease were used as end point.


RESULTS
During the follow-up period 24 patients had died with a diagnosis of ischemic heart or cerebrovascular disease, and 50 patients had been given such a diagnosis at hospital discharge. Age (OR 1.12, CI 1.06-1.19), previous history of angina pectoris (OR 9.69, CI 2.06-71.61), pathological ECG at emergency department visit (OR 3.27, CI 1.23-8.67), hypertension (OR 5.03, CI 1.90-13.76), smoking (OR 3.04, CI 1.26-7.63) and lipid lowering medication (OR 14.9, CI 1.60-152.77) were all associated with future ischemic heart or cerebrovascular events. Noradrenalin levels were higher in the event group than in the non-event group, mean (SD) 2.44 (1.02) nmol/L versus 1.90 (0.75) nmol/L. When noradrenalin was included in the regression model high maximal exercise capacity was protective of an event (OR 0.986, CI 0.975-0.997).


CONCLUSIONS
In chest pain patients previous history of angina pectoris, hypertension, smoking, pathological ECG at primary examination, and age were the main risk factors associated with future cardiovascular or cerebrovascular events.
Institute of Medicine, Dept of Molecular and Clinical Medicine, Sahlgrenska University Hospital, S 41345 Gothenburg, Sweden. inger.m.bengtsson@vgregion.se
Inger
I
Bengtsson
Björn W
BW
Karlson
Johan
J
Herlitz
Maria Haglid
MH
Evander
Peter
P
Währborg
D002637:Chest Pain / Q000097:blood* / Q000150:complications / Q000523:psychology*; D004298:Dopamine / Q000097:blood; D004837:Epinephrine / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008297:Male; D008875:Middle Aged; D009638:Norepinephrine / Q000097:blood; D013315:Stress, Psychological / Q000209:etiology; D013997:Time Factors
D004298:Dopamine; D006854:Hydrocortisone; D009638:Norepinephrine; D004837:Epinephrine