The prognosis for patients with new-onset angina who have undergone cardiac catheterization.

Abstract

The prognostic significance of new-onset angina was investigated in patients in whom coronary anatomic characteristics were known. New onset angina was defined as angina of less than 3 mo. duration. Consecutive patients (n = 1727) with significant coronary artery disease (diagnosed at cardiac catheterization) and who had not had a prior myocardial infarction or congestive heart failure were studied. In patients with new-onset angina (n = 329) there were a higher incidence of single-vessel disease (43% vs. 27%) and a lower incidence of triple-vessel (23% vs. 35%) and left main artery (5% vs. 10%) diseased compared with patients with chronic angina (n = 1398). Patients were classiifed by the presence or absence of preinfarction angina (severe and prolonged angina at rest requiring hospitalization to rule out myocardial infarction). In patients treated without surgery and who did not have preinfarction angina, survival at 1 yr was 97% for patients with new-onset angina and 98% for those with chronic angina (P = 0.27). Among patients not treated surgically who did not have preinfarction angina, at 1 yr 16% with new-onset angina and 7% with chronic angina had suffered a cardiac event (nonfatal myocardial infarction or death, P = 0.006). In patients treated surgically who did not have preinfarction angina, survival at 1 yr was 96% both for those with new-onset angina and those with chronic angina (P = 0.99). The risk of an event in patients treated surgically at 1 yr was not statistically different in patients with new-onset angina and those with chronic angina (12% vs. 11%, P = 0.27). Survival and event-free rates were lower in patients with preinfarction angina than in patients who did not have it. The nonsurgically and surgically treated patients with new-onset preinfarction angina remained at higher risk of an event than patients with preinfarction angina and a history of chronic angina. In patients who underwent cardiac catheterization there were no significant differences in survival rates between those with new-onset angina and those with chronic angina. However, patients with new-onset angina were at increased risk of a cardiac event, despite less severe anatomic disease.