Scholz Manfred, Wegener Katlin, Unverdorben Martin, Klepzig Harald
Herz- und Kreislaufzentrum, Rotenburg an der Fulda, Germany.
Herz. 2003 Aug;28(5):413-20. doi: 10.1007/s00059-003-2295-0.
Short-term prognosis of patients with chest pain and angiographically smooth coronary arteries is good in terms of development of coronary events (fatal or nonfatal myocardial infarction, coronary death, new coronary heart disease), but long-term studies are rare.
185 consecutive patients (mean age 54 +7.8 years, 59% male)with typical angina pectoris or atypical chest pain who underwent coronary angiography between 1980 and 1989 and had completely normal coronary arteries and left ventricular function (mean ejection fraction 68%) were followed over a period of 12.0 +/- 2.9 years. Exercise tests showed ischemia in 51 patients (ECG) and 21 patients (myocardial scintigraphy), respectively. 173 patients could be recruited for follow-up.
One patient died from acute myocardial infarction (0.05% per year). Nine patients died potentially from cardiac causes (0.51% per year) and seven from extracardial diseases. No nonfatal myocardial infarctions were documented. Six patients developed an angiographically documented coronary heart disease with significant stenoses after a mean follow-up of 12.7 years (0.3% per year). These patients had significantly more coronary risk factors than patients without coronary heart disease (2.8 vs. 1.8; p < 0.05) but not more often pathologic findings in rest-ECG (28% vs. 36%; not significant [n.s.]) and exercise test-ing (14% vs. 32%; n.s.). Frequency and intensity of chest pain remained unchanged in 34% of the patients. Symptoms regressed in more patients with an initially negative exercise test compared to patients who had a positive exercise test (78% vs. 54%;p < 0.05). The decrease in patients taking nitrates did not differ significantly between both groups (-42% vs. -27%; n.s.).
Patients suffering from angina-like chest pain with normal coronary angiograms have a good long-term prognosis which does not differ from the general population of the same age. Patients with positive stress tests will have less relief from their symptoms than patients with a negative stress test over many years.
胸痛且冠状动脉造影显示血管光滑的患者，就冠状动脉事件（致命或非致命性心肌梗死、冠状动脉死亡、新发冠心病）的发生而言，短期预后良好，但长期研究较少。
对1980年至1989年间连续185例（平均年龄54±7.8岁，59%为男性）患有典型心绞痛或非典型胸痛且接受冠状动脉造影检查、冠状动脉完全正常且左心室功能正常（平均射血分数68%）的患者进行了为期12.0±2.9年的随访。运动试验分别显示51例患者（心电图）和21例患者（心肌闪烁显像）存在缺血。173例患者可纳入随访。
1例患者死于急性心肌梗死（每年0.05%）。9例患者可能死于心脏原因（每年0.51%），7例死于心外疾病。未记录到非致命性心肌梗死。平均随访12.7年后，6例患者出现冠状动脉造影记录的伴有明显狭窄的冠心病（每年0.3%）。这些患者的冠状动脉危险因素显著多于无冠心病的患者（2.8比1.8；p<0.05），但静息心电图的病理表现（28%比36%；无显著性差异[n.s.]）和运动试验（14%比32%；n.s.）的发生率并不更高。34%的患者胸痛频率和强度保持不变。与运动试验阳性的患者相比，运动试验最初为阴性的患者症状缓解的更多（78%比54%；p<0.05）。两组服用硝酸盐类药物患者的减少率无显著差异（-42%比-27%；n.s.）。
冠状动脉造影正常的心绞痛样胸痛患者长期预后良好，与同年龄的普通人群无异。多年来，运动试验阳性的患者症状缓解程度低于运动试验阴性的患者。
