Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events

TY - JOUR

T1 - Stable angina pectoris with no obstructive coronary artery disease is associated with increased risks of major adverse cardiovascular events

AU - Jespersen, Lasse

AU - Hvelplund, Anders

AU - Abildstrøm, Steen Z

AU - Pedersen, Frants

AU - Galatius, Søren

AU - Madsen, Jan K

AU - Jørgensen, Erik

AU - Kelbæk, Henning

AU - Prescott, Eva

PY - 2012/3

Y1 - 2012/3

N2 - Aims Patients with chest pain and no obstructive coronary artery disease (CAD) are considered at low risk for cardiovascular events but evidence supporting this is scarce. We investigated the prognostic implications of stable angina pectoris in relation to the presence and degree of CAD with no obstructive CAD in focus.Methods and resultsWe identified 11 223 patients referred for coronary angiography (CAG) in 19982009 with stable angina pectoris as indication and 5705 participants from the Copenhagen City Heart Study for comparison. Main outcome measures were major adverse cardiovascular events (MACE), defined as cardiovascular death, myocardial infarction, stroke or heart failure, and all-cause mortality. Significantly more women (65) than men (32) had no obstructive CAD (P< 0.001). In Coxs models adjusted for age, body mass index, diabetes, smoking, and use of lipid-lowering or antihypertensive medication, hazard ratios (HRs) associated with no obstructive CAD were similar in men and women. In the pooled analysis, the risk of MACE increased with increasing degrees of CAD with multivariable-adjusted HRs of 1.52 (95 confidence interval, 1.271.83) for patients with normal coronary arteries and 1.85 (1.512.28) for patients with diffuse non-obstructive CAD compared with the reference population. For all-cause mortality, normal coronary arteries and diffuse non-obstructive CAD were associated with HRs of 1.29 (1.071.56) and 1.52 (1.241.88), respectively. Conclusion Patients with stable angina and normal coronary arteries or diffuse non-obstructive CAD have elevated risks of MACE and all-cause mortality compared with a reference population without ischaemic heart disease.

AB - Aims Patients with chest pain and no obstructive coronary artery disease (CAD) are considered at low risk for cardiovascular events but evidence supporting this is scarce. We investigated the prognostic implications of stable angina pectoris in relation to the presence and degree of CAD with no obstructive CAD in focus.Methods and resultsWe identified 11 223 patients referred for coronary angiography (CAG) in 19982009 with stable angina pectoris as indication and 5705 participants from the Copenhagen City Heart Study for comparison. Main outcome measures were major adverse cardiovascular events (MACE), defined as cardiovascular death, myocardial infarction, stroke or heart failure, and all-cause mortality. Significantly more women (65) than men (32) had no obstructive CAD (P< 0.001). In Coxs models adjusted for age, body mass index, diabetes, smoking, and use of lipid-lowering or antihypertensive medication, hazard ratios (HRs) associated with no obstructive CAD were similar in men and women. In the pooled analysis, the risk of MACE increased with increasing degrees of CAD with multivariable-adjusted HRs of 1.52 (95 confidence interval, 1.271.83) for patients with normal coronary arteries and 1.85 (1.512.28) for patients with diffuse non-obstructive CAD compared with the reference population. For all-cause mortality, normal coronary arteries and diffuse non-obstructive CAD were associated with HRs of 1.29 (1.071.56) and 1.52 (1.241.88), respectively. Conclusion Patients with stable angina and normal coronary arteries or diffuse non-obstructive CAD have elevated risks of MACE and all-cause mortality compared with a reference population without ischaemic heart disease.

U2 - 10.1093/eurheartj/ehr331

DO - 10.1093/eurheartj/ehr331

M3 - Journal article

C2 - 21911339

SN - 0195-668X

VL - 33

SP - 734

EP - 744

JO - European Heart Journal

JF - European Heart Journal

IS - 6

ER -