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Long-term prognostic factors for cardiovascular events in patients with chest pain without diabetes mellitus nor significant coronary stenosis

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A Correction to this article was published on 29 March 2024

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Abstract

Chest pain is the most common symptom of coronary artery disease (CAD) and diabetes mellitus (DM) is a well-known single strongest risk factor for cardiovascular diseases. Thus, the impact of CAD nor DM on long-term clinical effects is reported widely, but the prognostic factors of non-DM patients presenting with chest pain without significant CAD are limited. A total of 1,046 patients with chest pain without DM and significant CAD who underwent coronary angiography (CAG) and acetylcholine (ACH) provocation tests were finally enrolled. Propensity score matching and multivariate Cox-proportional hazard ratio analysis were performed to adjust for baseline potential confounders. Major adverse cardiac and cerebrovascular events (MACCE) were defined as the composite of total death, myocardial infarction (MI), revascularization, stroke, and recurrent angina. This study aimed to evaluate the long-term prognostic factors for MACCE in patients with chest pain without DM and CAD up to 5 years. Coronary artery spasm (CAS) was the most common cause of chest pain. However, long-term MACCE of CAS was not worse than those of patients with chest pain without CAS when patients with CAS had subsequent optimal antianginal medication therapy. However, a recurrent chest pain remains a problem even with continuous antianginal medication therapy. Up to 5 years, the incidence of MACCE was in 7.3%, including recurrent angina 6.9%. Dyslipidemia (HR: 2.010, 95% CI 1.166–3.466, P = 0.012), mild–moderate (30–70%) coronary stenosis (HR: 2.369, 95% CI 1.118–5.018, P = 0.024), the use of aspirin (HR: 2.885, 95% CI 1.588–5.238, P < 0.001), and the use of nitrates (HR: 1.938, 95% CI 1.094–3.433, P = 0.023) were independent risk factors for MACCE. Among the patients with chest pain without DM and significant CAD, the incidence of MACE were rare, but recurrent angina was still a challenging problem who had treated with antianginal medications.

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  1. Seung-Woon Rha and Kyuho Lee are co-first authors.

Authors and Affiliations

  1. Cardiovascular Center, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea

    Seung-Woon Rha

  2. Division of Cardiology, Department of Internal Medicine, Hwahong Hospital, Suwon, Korea

    Kyuho Lee

  3. Cardiovascular Research Institute, Korea University, 198, Gamasan-ro, Guro-gu, Seoul, 08309, Korea

    Se Yeon Choi, Jae Kyeong Byun, Jinah Cha, Sujin Hyun, Woo Jin Ahn, Soohyung Park, Dong Oh Kang, Eun Jin Park, Cheol Ung Choi & Byoung Geol Choi

  4. Division of Cardiology, Department of Internal Medicine, Hwahong Hospital, Seoul, Korea

    Kyuho Lee

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Rha, SW., Lee, K., Choi, S. et al. Long-term prognostic factors for cardiovascular events in patients with chest pain without diabetes mellitus nor significant coronary stenosis. Heart Vessels 39, 382–391 (2024). https://doi.org/10.1007/s00380-023-02348-4

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