Cardiac catheterization reduces resource utilization in patients with chronic chest pain

The evaluation of patients with recurrent chest pain accounts for a signifi cant proportion of the $274 billion annual cast of cardiovascular services in the United States. Our investigation examines the impact of coronary ang iography on subsequent use of medical resources for evaluation of chest pai n symptoms. The study seeks to determine whether a finding of noncritical c oronary artery disease on cardiac catheterization leads to a reduced use of resources for subsequent evaluation and treatment of chest pain syndromes. Our study included 22 consecutive patients who had sought evaluation for c hest pain symptoms, and who had persistence of symptoms after functional te sting. Cardiac catheterization demonstrated angiographically mild coronary artery disease (stenosis less than 50%) in these patients. The patient coho rt accounted for 22 emergency room evaluations and 41 ambulatory clinic eva luations in the 2.5 years before cardiac catheterization. In the 2.5-year p eriod after catheterization, these patients had only 3 emergency room visit s and 41 ambulatory clinic visit for chest pain evaluation (P < 0.001). The re was a significant reduction in the number of prescriptions written for t opical and oral nitrates (32% precatheterization vs. 5% pastcatheterization , P < 0.04), but not of beta-blockers (26% vs. 21%, P = 0.53) or calcium bl ockers (32% vs. 32%, P = 1.0). Furthermore, most of the 21 surviving patien ts were found subsequently to have a noncardiac basis for their pain: peric arditis was felt to be the cause of chest pain in 4 patients;, pulmonary di sease in 7 patients, and gastrointestinal conditions in 8 patients. Diagnos tic coronary arteriography may identify a subset of patients in whom a find ing of noncritical coronary artery disease leads to a reduction in physicia n visits for evaluation of chest pain syndromes and reduced use of nitrates . In addition, when coronary artery disease is known to be mild, a noncardi ac etiology for the chest pain can be sought. These results may decrease th e use of expensive medical resources and encourage full occupational and li festyle rehabilitation. (C) 2000 Wiley-Liss, Inc.