Burden of hospital admission and repeat angiography in angina pectoris patients with and without coronary artery disease: a registry-based cohort study.
OBJECTIVE
To evaluate risk of hospitalization due to cardiovascular disease (CVD) and repeat coronary angiography (CAG) in stable angina pectoris (SAP) with no obstructive coronary artery disease (CAD) versus obstructive CAD, and asymptomatic reference individuals.


RESULTS
We followed 11,223 patients with no prior CVD having a first-time CAG in 1998-2009 due to SAP symptoms and 5,695 asymptomatic reference individuals from the Copenhagen City Heart Study through registry linkage for 7.8 years (median). In recurrent event survival analysis, patients with SAP had 3-4-fold higher risk of hospitalization for CVD irrespective of CAG findings and cardiovascular comorbidity. Multivariable adjusted hazard ratios(95%CI) for patients with angiographically normal coronary arteries was 3.0(2.5-3.5), for angiographically diffuse non-obstructive CAD 3.9(3.3-4.6) and for 1-3-vessel disease 3.6-4.1(range)(all P<0.001). Mean accumulated hospitalization time was 3.5(3.0-4.0)(days/10 years follow-up) in reference individuals and 4.5(3.8-5.2)/7.0(5.4-8.6)/6.7(5.2-8.1)/6.1(5.2-7.4)/8.6(6.6-10.7) in patients with angiographically normal coronary arteries/angiographically diffuse non-obstructive CAD/1-, 2-, and 3-vessel disease, respectively (all P<0.05, age-adjusted). SAP symptoms predicted repeat CAG with multivariable adjusted hazard ratios for patients with angiographically normal coronary arteries being 2.3(1.9-2.9), for angiographically diffuse non-obstructive CAD 5.5(4.4-6.8) and for obstructive CAD 6.6-9.4(range)(all P<0.001).


CONCLUSIONS
Patients with SAP symptoms and angiographically normal coronary arteries or angiographically diffuse non-obstructive CAD suffer from considerably greater CVD burdens in terms of hospitalization for CVD and repeat CAG compared with asymptomatic reference individuals even after adjustment for cardiac risk factors and exclusion of cardiovascular comorbidity as cause. Contrary to common perception, excluding obstructive CAD by CAG in such patients does not ensure a benign cardiovascular prognosis.
Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark.
Lasse
L
Jespersen
Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark.
Steen Z
SZ
Abildstrom
National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
Anders
A
Hvelplund
Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
Jan K
JK
Madsen
Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark.
Soren
S
Galatius
Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark.
Frants
F
Pedersen
Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark.
Soren
S
Hojberg
Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark; Copenhagen City Heart Study, Bispebjerg University Hospital, Copenhagen, Denmark.
Eva
E
Prescott
D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000150:complications / Q000000981:diagnostic imaging* / Q000191:economics* / Q000453:epidemiology; D000792:Angiography / Q000191:economics / Q000706:statistics & numerical data; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000191:economics* / Q000453:epidemiology; D003718:Denmark / Q000453:epidemiology; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics* / Q000706:statistics & numerical data; D012008:Recurrence; D012042:Registries