title: Suspected coronary artery disease and myocardial infarction with normal coronary angiography: a heterogeneous but benign condition?
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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).
  
  
  CONCLUSIONS
  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.
authors: Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. nadia.moreira5@gmail.com
authors: Nádia
authors: N
authors: Moreira
authors: Maria João
authors: MJ
authors: Vidigal Ferreira
authors: Francisco
authors: F
authors: Soares
authors: Beatriz
authors: B
authors: Santos
authors: Ana
authors: A
authors: Miranda
authors: Lino
authors: L
authors: Gonçalves
authors: Luís
authors: L
authors: Providência
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis*; D005188:False Negative Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis*; D012189:Retrospective Studies