Long-term prognosis of patients with cardiac syndrome X

doi:10.1016/j.ijcard.2008.11.026

International Journal of Cardiology

Volume 140, Issue 2, 15 April 2010, Pages 197-199

https://doi.org/10.1016/j.ijcard.2008.11.026 Get rights and content

Abstract

Background

Previous follow-up studies of patients with cardiac syndrome X (CSX) reported good prognosis. However, some recent reports challenged this finding by showing appreciable mortality rates in patients with angina and normal coronary arteries admitted for acute coronary syndromes.

Methods

We performed clinical follow-up of 155 patients (mean age 58.9 ± 10 years, 40 men) with typical CSX. The occurrence of major cardiac events (cardiac death, acute myocardial infarction), readmission for chest pain, revascularization procedures, angina status, and non cardiac events during follow-up were collected for each patient.

Results

At a mean follow-up time of 137 ± 78 months (range 24–372) from the onset of symptoms, 4 patients died, 3 for cancers and 1 for acute pancreatitis. No patient died from cardiovascular causes or had any major cardiovascular event. Hospital readmission for recurrent chest pain was reported by 89 patients (58%), and 33 (22%) underwent at least one more coronary angiography. During follow-up, chest pain had remained unchanged in 33% of patients and had worsened in 14% of patients.

Conclusion

Our data show that patients with CSX have excellent long-term clinical prognosis. A significant number of patients, however, shows persistence or worsening of symptoms, as well as further recurrence to medical evaluation.

Section snippets

Patients

We performed clinical follow-up of 155 patients who were diagnosed to have CSX at our Institute according to typical clinical features, including angina episodes exclusively or mainly related to efforts, a positive symptom/sign limited exercise stress test and completely normal epicardial coronary arteries at angiography. Coronary artery spasm was excluded by intracoronary or intravenous ergonovine test, or intracoronary acetylcholine test, when clinical history suggested the possibility of

Results

Table 1 shows the main clinical features of patients, whereas a summary of clinical outcome is shown in Table 2. Mean age of patients at the time of symptom onset was 58.9 ± 10 years. Most patients were female (75%) and about a half of them had evidence of hypertension or hypercholesterolemia.

Follow-up time was on average 137 ± 78 months (range 24 to 372) from clear-cut onset of angina symptoms. Four patients died during this period, 3 for cancer and 1 for acute pancreatitis. No patient died from

Discussion

This study reports clinical outcome of the largest group of CSX patients with the longest follow-up time until now assessed in medical literature. Extending previous observations [1], [2], [3], [4], our data show that CSX patients have excellent long-term prognosis. Indeed, after a mean follow-up period of more than 11 years, none of our 155 CSX patients died from a cardiac cause neither had any major cardiovascular event, including non fatal AMI. Moreover, only 2 of our patients developed

Acknowledgement

The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [11].

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The aim of this study was to investigate the prognosis of a large cohort of patients with stable angina and unobstructed coronaries undergoing acetylcholine spasm testing.
Coronary artery spasm can be found in up to 60% of patients with symptoms of myocardial ischemia despite unobstructed coronary arteries.
Consecutive symptomatic patients with unobstructed coronary arteries undergoing acetylcholine testing to detect epicardial or microvascular coronary spasm were prospectively enrolled. After a median follow-up period of 7.2 years (6.5 to 7.9 years), data regarding mortality, nonfatal myocardial infarction, stroke, repeat coronary angiography, recurrent symptoms, and quality of life were obtained in 736 patients (57% women, mean age 62 ± 12 years).
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Citation Excerpt :
This may not only improve the understanding of the disease but also allow for better risk stratification and more aggressive medical treatment. Indeed, despite antianginal treatment ∼40% of patients with coronary vasomotor disorders were found to have refractory/recurrent symptoms.13 This underpins the high burden for our health care systems and the need for a better understanding of the underlying mechanisms.
Coronary spasm is frequently found in patients with angina and unobstructed coronaries. The pathophysiology is incompletely understood, although sex differences have been described. Often a positive family history (PFH) is encountered. We assessed the relationship between sex, coronary spasm, and a PFH for cardiovascular disease.
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There is a female preponderance among patients with angina and unobstructed coronaries. ACh testing enables detection of coronary spasm. Epicardial spasm in women is associated with a PFH.
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Long-term prognosis of patients with cardiac syndrome X

Abstract

Background

Methods

Results

Conclusion

Section snippets

Patients

Results

Discussion

Acknowledgement

Am J Cardiol

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Int J Cardiol