Morbidity and Use of Medical Resources in Patients With Chest Pain and Normal or Near-Normal Coronary Arteries

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Abstract

To evaluate morbidity and use of medical resources in patients with chest pain and normal or near-normal coronary angiograms: 2,639 consecutive patients who underwent coronary angiograms due to chest pain were registered. Two years thereafter all patients who showed normal or near-normal coronary angiograms were approached with a questionnaire regarding hospitalization during the last 4 years (2 years before and 2 years after angiography). All medical files were also examined. Of the patients who underwent angiography, 163 (6%) had no significant stenoses, and of these, 113 showed complete normal angiograms and 50 showed mild (i.e. <50%) stenoses. During the 2 years before diagnostic angiogram, 66% of the patients were hospitalized compared with only 35% during 2 years after angiography (p <0.001). The reduction in hospitalization was due to curtailed utilization of medical resources for cardiac reasons; mean days in hospital was 6.6 days before angiography versus 2.8 days after (p <0.001). There were no significant differences in hospitalization when comparing patients with mild stenoses and completely normal angiograms. There were, furthermore, no differences between patients with positive or negative exercise tests. Thus, the need for hospitalization is significantly reduced after a diagnostic angiogram reveals normal or near-normal coronary arteries.

Section snippets

Patient Population

Between May 1988 and May 1991, all patients who underwent diagnostic coronary angiography at 2 university hospitals and 1 community hospital were registered. At the time of registration these hospitals were the only centers performing coronary angiography in western Sweden, serving a population of 1.5 million. Four hundred twenty-one patients were excluded from the analysis since registration data were incomplete. Patients who previously had undergone coronary artery bypass grafting (n = 280),

Results

Of the patients undergoing angiography 2,476 were found to have significant coronary artery disease (group 3), and 163 (6%) were found to have nonsignificant coronary artery stenoses, of whom 113 had completely normal coronary arteries (group 2) and mild disease, defined as <50% stenoses, was found in 50 patients (group 1).

Demographic data and baseline characteristics are described in Table 1.

Regarding medical history, patients with coronary stenoses had more often suffered from previous

Discussion

Previously, long-term follow-up studies have shown an excellent outcome regarding cardiac death and myocardial infarction in patients with chest pain and a normal coronary angiogram.3, 4, 8, 9Hence, there seems to be reasons to discern between patients with mild disease and patients with completely normal angiograms. Bruschke et al[15]demonstrated that patients with entirely normal angiograms had an incidence of myocardial infarction and cardiac death of only 0.9% and 0.6%, respectively, during

Acknowledgements

We are grateful to Maria Haglid, Margareta Sjölin, and Maureen Jehler for their excellent technical assistance.

This study was supported by grants from the Medical Society of Göteborg, the Swedish Heart and Lung Foundation, Stockholm; and Astra Hässle AB, Mölndal, Sweden.

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