Stable isolated angina gives no warning of major events

Stable isolated angina gives no warning of major events

By Caroline Price

21 August 2007

Eur Heart J 2007; 28: 1928-1935

MedWire News: Patients with stable isolated angina have an excellent prognosis in terms of major cardiovascular (CV) events, investigators report.

But they note that since most deaths and CV events that occur in this group are not preceded by clear warning symptoms such as chest pain requiring hospitalization, measures to prevent such events should be targeted to all patients with isolated angina.

Philip Poole-Wilson (Imperial College London, UK) and colleagues looked at the clinical history and outcome of patients with isolated angina using data from ACTION (A Coronary disease Trial Investigating Outcome with Nifedipine GITS), which compared long-acting nifedipine with placebo in a wide range of stable, symptomatic angina patients.

“Contemporary data that specifically documents the clinical course of patients with isolated angina is lacking,” they observe.

Of 7665 patients included in the trial, 2170 (28%) had isolated angina, defined as stable angina due to coronary heart disease (CHD) without a history of CV events or revascularization.
During a mean follow-up of 4.9 years, 147 (1.4 per 100 patient-years) of this isolated angina group died, while 761 (8.7 per 100 patient-years) died or had a cardiac event or procedure.
This mortality rate in angina patients was similar to that of patients with a history of coronary revascularization, whereas the rate of cardiac events and procedures was lower, the authors note. Meanwhile, mortality as well as event and procedure rates for isolated angina patients were lower than those for the subgroup of patients with history of myocardial infarction, heart failure, or stroke.

The first event among isolated angina patients was death in 82 patients, myocardial infarction or heart failure in 112, coronary revascularization in 171, and chest pain requiring hospitalization in 396.

But just 68 (30%) of 262 deaths or major cardiac events were preceded by chest pain requiring hospitalization or revascularization.

Coronary angiography (CAG) was performed at least once in 612 (28%) isolated angina patients during follow up. In comparison with rates up to CAG or the end of follow-up, both death and CV event rates were higher after CAG.

“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,” the authors conclude in the European Heart Journal.

“Since the main clinical implication is that the majority of deaths and major CV events are not preceded by clear warning symptoms, the main clinical implication is that measures to prevent such events must target all patients.”

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