DEVELOPMENT OF ANGINA-PECTORIS PAIN AND CARDIAC EVENTS IN ASYMPTOMATIC PATIENTS WITH MYOCARDIAL-ISCHEMIA

A total of 389 patients with angiographically determined coronary arte ry disease, who exhibited a complete absence of angina pectoris in the presence of reproducible myocardial ischemia, were studied in a follo w-up investigation. After an initial coronary angiogram, anti-ischemic medication was prescribed as treatment. After a mean follow-up time o f 4.9 years (maximum 13.4 years) patients were sent a questionnaire th at assessed any new development of angina pectoris pain and cardiac ev ents. 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 (my ocardial infarction, bypass surgery or percutaneous transluminal coron ary angioplasty) occurred after 5 and 10 years 19 and 46%, respectivel y. 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 a degree of ischemia (defined by ST-segment depressio n free exercise tolerance, p = 0.04) proved to have independent predic tive value with respect to mortality rate. Newly developed angina pect oris 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 abs ence of pain can develop angina pectoris over the course of years and that newly developed pain often precedes cardiac events.