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Development of angina pectoris pain and cardiac events in asymptomatic patients with myocardial ischemia.
Am J Cardiol. 1993 Jul 15; 72(2):121-7.AJ

Abstract

A total of 389 patients with angiographically determined coronary artery disease, who exhibited a complete absence of angina pectoris in the presence of reproducible myocardial ischemia, were studied in a follow-up investigation. After an initial coronary angiogram, anti-ischemic medication was prescribed as treatment. After a mean follow-up time of 4.9 years (maximum 13.4 years) patients were sent a questionnaire that assessed any new development of angina pectoris pain and cardiac events. In 48 of these patients a second angiogram was recorded after a mean period of 4.2 years. Asymptomatic patients had a worse prognosis than an age-adjusted normal population. After 5 and 10 years, 9 and 26% of the patients, respectively, had died, nonfatal cardiac events (myocardial infarction, bypass surgery or percutaneous transluminal coronary angioplasty) occurred after 5 and 10 years in 19 and 46%, respectively. A large number of initially asymptomatic patients developed angina pectoris pain over the follow-up period (34% after 5 years, 58% after 10 years). Novel angina pectoris pain often preceded cardiac events by months to years. Multivariate analysis indicated that vessel disease (p = 0.0001) and degree of ischemia (defined by ST-segment depression free exercise tolerance, p = 0.04) proved to have independent predictive value with respect to mortality rate. Newly developed angina pectoris was associated with an increase in objective signs of myocardial ischemia and a progression in coronary stenosis. The results indicate that patients who originally had myocardial ischemia with a marked absence of pain can develop angina pectoris over the course of years and that newly developed pain often precedes cardiac events.

Authors+Show Affiliations

Benedikt Kreutz Cardiovascular Rehabilitation Center, Bad Krozingen, Germany.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

8328371

Citation

Droste, C, et al. "Development of Angina Pectoris Pain and Cardiac Events in Asymptomatic Patients With Myocardial Ischemia." The American Journal of Cardiology, vol. 72, no. 2, 1993, pp. 121-7.
Droste C, Ruf G, Greenlee MW, et al. Development of angina pectoris pain and cardiac events in asymptomatic patients with myocardial ischemia. Am J Cardiol. 1993;72(2):121-7.
Droste, C., Ruf, G., Greenlee, M. W., & Roskamm, H. (1993). Development of angina pectoris pain and cardiac events in asymptomatic patients with myocardial ischemia. The American Journal of Cardiology, 72(2), 121-7.
Droste C, et al. Development of Angina Pectoris Pain and Cardiac Events in Asymptomatic Patients With Myocardial Ischemia. Am J Cardiol. 1993 Jul 15;72(2):121-7. PubMed PMID: 8328371.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Development of angina pectoris pain and cardiac events in asymptomatic patients with myocardial ischemia. AU - Droste,C, AU - Ruf,G, AU - Greenlee,M W, AU - Roskamm,H, PY - 1993/7/15/pubmed PY - 1993/7/15/medline PY - 1993/7/15/entrez SP - 121 EP - 7 JF - The American journal of cardiology JO - Am. J. Cardiol. VL - 72 IS - 2 N2 - A total of 389 patients with angiographically determined coronary artery disease, who exhibited a complete absence of angina pectoris in the presence of reproducible myocardial ischemia, were studied in a follow-up investigation. After an initial coronary angiogram, anti-ischemic medication was prescribed as treatment. After a mean follow-up time of 4.9 years (maximum 13.4 years) patients were sent a questionnaire that assessed any new development of angina pectoris pain and cardiac events. In 48 of these patients a second angiogram was recorded after a mean period of 4.2 years. Asymptomatic patients had a worse prognosis than an age-adjusted normal population. After 5 and 10 years, 9 and 26% of the patients, respectively, had died, nonfatal cardiac events (myocardial infarction, bypass surgery or percutaneous transluminal coronary angioplasty) occurred after 5 and 10 years in 19 and 46%, respectively. A large number of initially asymptomatic patients developed angina pectoris pain over the follow-up period (34% after 5 years, 58% after 10 years). Novel angina pectoris pain often preceded cardiac events by months to years. Multivariate analysis indicated that vessel disease (p = 0.0001) and degree of ischemia (defined by ST-segment depression free exercise tolerance, p = 0.04) proved to have independent predictive value with respect to mortality rate. Newly developed angina pectoris was associated with an increase in objective signs of myocardial ischemia and a progression in coronary stenosis. The results indicate that patients who originally had myocardial ischemia with a marked absence of pain can develop angina pectoris over the course of years and that newly developed pain often precedes cardiac events. SN - 0002-9149 UR - https://www.unboundmedicine.com/medline/citation/8328371/Development_of_angina_pectoris_pain_and_cardiac_events_in_asymptomatic_patients_with_myocardial_ischemia_ L2 - https://linkinghub.elsevier.com/retrieve/pii/0002-9149(93)90146-4 DB - PRIME DP - Unbound Medicine ER -