The anginal syndrome associated with normal coronary arteriograms. Report of a six year experience

Although the occurrence of normal coronary arteriograms in patients with anginal pain is now recognized as a clinical entity, a large-scale study of such patients has not been reported. Accordingly, the historic aspects, laboratory findings and subsequent clinical course of 200 subjects (101 men and 99 women) with this syndrome were analyzed. Their average age was 47 years. No specific feature in the history could be discerned which separated these patients from those with angina due to coronary heart disease. The frequency of noncardiac sources of chest pain was similar in all patients. The electrocardiogram demonstrated abnormalities in the ST-T waves in slightly over 50 per cent of the patients, and the postexercise electrocardiogram was abnormal in another 20 per cent. Objective evidence for myocardial ischemia (myocardial lactate production) was three times more frequent in women than in men. The frequency of carbohydrate and/or lipid abnormalities was approximately half that in patients with coronary heart disease and did not correlate with the presence of myocardial ischemia. Long-term follow-up of these patients indicated that over half showed gradual improvement without specific therapy, whereas only 8 per cent had an increase in chest pain. Six patients died (four of unknown cause) in an average follow-up period of three years. Mortality, however, as determined by the life table method, was no greater than in a sex-age matched cohort derived from actuarial data. Although the etiology of this syndrome has not yet been demonstrated, its prognosis both in terms of persistence of pain and mortality appears to be benign.