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The diagnostic and prognostic value of angina type are understudied in the contemporary era.
Stable patients without known CAD undergoing cardiac cath were used to define associations of angina type and stress test results with CAD prevalance and long-term outcomes.
17,182 patients underwent initial catheterization between 1996-2010. Typical angina was present in 5867 (34%), atypical in 5850 (34%), non-anginal in 313 (2%) and no pain in 5152 (30%). The highest rate of CAD (75%) was found in those with typical angina and a negative stress test, while the lowest rate (11%) was found with non-anginal pain and a positive stress test. Patients with typical pain had the highest 1y revascularization rates and 10y MI rates (61% and 8%) while those with non-anginal pain had the lowest (12% and 3%). Multivariable adjusted hazard rates for death, MI, and revascularization (figure) demonstrate the highest risk of death in those without pain and the highest risk of revascularization with typical pain. Consequently, > 10 yr Kaplan-Meier analysis demonstrated higher survival in those with a positive vs negative stress test (p=0.0001).
Anginal symptoms are strongly associated with CAD prevalence and long-term outcomes regardless of stress test result. Patients referred for cath despite a negative stress test were more likely to have typical angina, CAD, and worse long-term outcomes. Understanding patients’ clinical symptoms remains important in the modern era of testing.
Moderated Poster Contributions
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: The Best of Risk Stratification in SIHD
Abstract Category: 10. Chronic CAD/Stable Ischemic Heart Disease: Clinical
Presentation Number: 1110M-71
- 2013 American College of Cardiology Foundation