CLINICAL PRESENTATION AND FUNCTIONAL PROGNOSIS IN SYNDROME-X

Objectives-To assess the effect of clinical presentation on functional prognosis in patients with syndrome X. Design-A prospective study. Pa tients with syndrome X presenting with unstable angina and stable angi na were followed up with a questionnaire to examine their functional s tate. Patients-41 patients with syndrome X and unstable angina and 41 patients with syndrome X and stable angina. Syndrome X was defined as typical anginal chest pain, a positive exercise test, and normal coron ary angiogram. Setting-Regional cardiothoracic centre. Results-The mea n follow up time was 36 (range 20-51) months for the unstable angina g roup and 35 (range 19-51) months for the stable angina group. No patie nt was lost to follow up in either group. At follow up 28 patients in the unstable angina group were pain free compared with 15 patients in the stable angina group (p = 0.008). Seven patients in the unstable an gina group had further hospital admission with chest pain after the ca rdiac catheterisation compared with 12 patients in the stable angina g roup (NS). Seven patients in the unstable angina group believed that t hey had heart disease compared with 27 in the stable angina group (p < 0.001). 26 patients in the unstable angina group but only eight patie nts in the stable angina group were unlimited in their physical activi ty (p < 0.001). 12 patients in the unstable angina group compared with 27 patients in the stable angina group were unable to work normally b ecause of chest pain (p < 0.001). The mean (SD) duration of symptoms b efore cardiac catheterisation was 7.9 (4.7) months in the unstable ang ina group and 13.4 (5.6) months in the stable angina group (p < 0.001) . 10 patients in the unstable angina group and 24 patients in the stab le angina group still attended hospital outpatient clinics because of chest pain (p = 0.004). 16 patients in the unstable angina group and 2 9 patients in the stable angina group were still taking regular antian ginal medication (p < 0.001). Conclusions-Patients with syndrome X who present with unstable angina have a significantly better functional p rognosis than those presenting with symptoms of stable angina. This ma y reflect differences in underlying pathophysiological mechanisms.