European Heart Journal Advance Access originally published online on June 11, 2007
European Heart Journal 2007 28(16):1928-1935; doi:10.1093/eurheartj/ehm198
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Clinical course of isolated stable angina due to coronary heart disease
1 Cardiac Medicine, National Heart and Lung Institute, Imperial College London, London, UK
2 Department of Preventive Medicine, Faculty of Public Health, Medical and Health Sciences Centre, University of Debrecen, Debrecen, Hungary
3 SOCAR Research, Nyon, Switzerland
4 Amphia Ziekenhuis, Breda, The Netherlands
5 Department of Epidemiology and Biostatistics, Erasmus Medical Centre, Rotterdam, The Netherlands
Received 2 February 2007; accepted 26 April 2007; online publish-ahead-of-print 11 June 2007.
* Corresponding author. Tel: +44 20 7351 8179; fax: +44 20 7351 8113. E-mail address: p.poole-wilson{at}imperial.ac.uk
Aims: To describe the clinical course of patients with stable angina due to coronary heart disease without a history of cardiovascular (CV) events or revascularization (isolated angina).
Methods and results: Of 7665 patients in a trial comparing long-acting nifedipine with placebo, 2170 (28%) had isolated angina. During a mean follow-up of 4.9 years, 147 of these died (1.4/100 patient-years), while 761 (8.7/100 patient-years) either died, or had a cardiac event or procedure. The first event was death in 82, myocardial infarction or heart failure in 112, coronary revascularization in 171, and chest pain requiring hospitalization in 396. Six hundred and twelve patients (6.8/100 patient-years) underwent coronary angiography (CAG), followed by revascularization in 371. Sixty-eight of 262 deaths or major cardiac events were preceded by chest pain requiring hospitalization or revascularization. Event-rates after CAG were higher than before. The stroke rate was 0.7/100 patient-years (75 patients).
Conclusion: Patients with stable isolated angina have low rates of death and major cardiac events, but relatively high rates of chest pain requiring hospitalization despite contemporary management. Since the majority of deaths and major CV clinical events are not preceded by clear warning symptoms, the main clinical implication is that measures to prevent such events must target all patients.
Key Words: Coronary heart disease • Angina • Natural history • Secondary prevention • Coronary angiography • Revascularization
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