ANGIOGRAPHIC PROGRESSION IN PATIENTS WITH ANGINA-PECTORIS AND NORMAL OR NEAR NORMAL CORONARY ANGIOGRAMS WHO ARE RESTUDIED DUE TO UNSTABLE SYMPTOMS

Background Syndrome X patients commonly remain symptomatic during foll ow-up and may be readmitted with unstable anginal symptoms. Angiograph ic disease progression must be considered as a possible mechanism for instability, particularly where multiple coronary risk factors are pre sent and an interval of several years has elapsed since previous angio graphy. Methods and Results We reviewed data from 139 consecutive pati ents with chest pain and normal or near normal coronary angiograms (10 1 patients with completely normal angiograms and 38 patients with mini mal lumenal irregularities). During a 5-year period, 24 patients (19 w omen, median age 56 years) underwent repeat angiography due to primary unstable angina (median interval between angiograms 58 months (range 8-130 months)). This group included three patients with minimal lumena l irregularities and four patients with left bundle branch block. Only two patients had progression to significant angiographic stenosis (>3 0% diameter reduction); both were male patients with minimal irregular ities at baseline angiography, left bundle branch block and multiple c oronary risk factors. However, overall only two of 18 (11%) patients w ith one or more conventional coronary risk factors had angiographic pr ogression. Conclusions Unstable symptoms in patients with chest pain a nd previously normal or near normal coronary arteriograms are rarely d ue to angiographic disease progression. However, the presence of minim al lumenal irregularities at baseline angiography and LBBB may identif y a sub-group at increased risk.