NONSPECIFIC CHEST PAIN ASSOCIATED WITH HIGH LONG-TERM MORTALITY - RESULTS FROM THE PRIMARY PREVENTION STUDY IN GOTEBORG, SWEDEN

Background: The syndrome angina pectoris with effort-related chest pai n or discomfort is usually easy to recognize. However, vague and nonsp ecific symptoms may cause little reason for extensive evaluation. The prognosis of such patients in the general population has so far not be en well described. Hypothesis: The study was undertaken to investigate long-term prognosis in men with chest pain considered to be nonspecif ic in comparison with men with typical angina pectoris (AP) or prior m yocardial infarction (MI), and men without chest pain. Methods: At the second screening of the Goteborg Primary Prevention Study in 1974-197 7, 6,488 men aged 51 to 59 years at baseline were available for the pr esent analysis. Men who had responded positively to a postal questionn aire about chest pain during exercise or at rest were interviewed by a physician according to a Rose questionnaire at the screening examinat ion. Those with typical or probable AP were further examined by a sing le experienced physician. The following four groups were formed: Group 1: men who did not complain of chest pain (n = 5,545). Group 2: men w ho had not consulted any doctor because of chest pain, but who had che st pain according to a questionnaire (n = 441); these men were not con sidered to have AP according to a three-step examination by experience d physicians. Group 3: typical AP (n = 232). Group 4: men who had suff ered an MI (n = 134). Results: During 16 years of follow-up, coronary heart disease (CHD) mortality for Groups 1-4 was 8.0, 19.5, 24.8, and 48.5%, respectively. Mortality from all cardiovascular diseases was 11 .5, 24.5, 31.2, and 59.0%, respectively. Noncardiovascular disease mor tality was 14.1, 17.7, 14.3, and 8.7%, respectively. Thus, the relativ e risk (RR) for CHD mortality among men with nonspecific chest pain (G roup 2) was 2.77 [95% confidence interval (CI) 2.20, 3.50], far all ca rdiovascular disease mortality 2.46 (95% CT 2.00, 3.02), and for nonca rdiovascular disease mortality 1.60 (95% CI 1.28, 2.00). Total mortali ty in this group was as high (44%) as among those with typical AP (45% ), but the highest mortality was found among men with a previous MI (6 8%). in men without chest pain it was 26%. Patients of Groups 2-4 had higher levels of cardiovascular risk factors than those in Group 1. Ne ither any specific questions in the Rose questionnaire, nor electrocar diographic changes at rest (uncommon) were of prognostic significance. Serum cholesterol, systolic blood pressure, diabetes, and smoking wer e significant predictors of outcome, both with respect to fatal CHD an d to total mortality during the 16-year follow-up. Conclusion: We foun d a high cardiovascular as well as noncardiovascular mortality among p atients with chest pain who had not been considered to have AP at a th ree-step examination procedure. It is important to be suspicious of ea rly CHD symptoms in men (and women?) with ''nonspecific'' chest sympto ms and to analyze their cardiovascular risk factor pattern further bec ause they are at considerably higher risk for future events than those in whom CHD is not suspected.