Prognosis of patients with previous myocardial infarction, coronary slow flow, and normal coronary angiogram

• Published in: Herz Vol. 45; no. Suppl 1; pp. 88 - 94
• Main Authors: Zivanic, A., Stankovic, I., Ilic, I., Putnikovic, B., Neskovic, A. N.
• Format: Journal Article
• Language: English
• Published: Heidelberg Springer Medizin 01-12-2020; Springer Nature B.V
• Subjects: Adult; Aged; Angiography; Cardiology; Coronary Angiography; Coronary artery; Coronary vessels; Drug therapy; EKG; Electrocardiography; Heart; Heart attacks; Humans; Internal Medicine; Male; Medical prognosis; Medicine; Medicine & Public Health; Middle Aged; Myocardial infarction; Myocardial Infarction - diagnostic imaging; Original Articles; Patients; Pharmacology; Prognosis; Retrospective Studies; Risk analysis; Risk factors; Stroke Volume; Survival; Ventricle; Ventricular Function, Left; Prognose; Prognosis; Risikofaktoren; Angiography; Herzanfall; Coronary stenosis; Koronarstenose; Heart attack; Risk factors; Angiographie
• ISSN: 0340-9937; 1615-6692
• DOI: 10.1007/s00059-019-4817-4

Background
There is a common assumption that patients with coronary slow flow (CSF) have an excellent prognosis in the absence of coronary artery stenoses. Little is known about whether a history of previous coronary events affects the long-term survival in this population. In this retrospective, observational study, we assessed the possible association of a previous coronary event and long-term prognosis in patients with CSF but without significant coronary artery stenoses.
Methods
A total of 141 patients (70 male; median age: 59 years, range: 33–78 years) with CSF and normal coronary angiograms were included in the study. Patients were followed up for all-cause mortality during a period of 47 ± 22 months.
Results
Previous myocardial infarction (MI) was reported by 16 (11%) patients who had similar left ventricular ejection fraction (LVEF) as those without previous MI (51 ± 16 vs. 53 ± 16%,
p
 = 0.595). Patients with previous MI more often had an abnormal resting electrocardiogram (69 vs. 40%,
p
 = 0.03), while there were no significant differences in other baseline clinical characteristics (
p
 > 0.05 for age, gender, risk factors, pharmacological treatment). In univariate Cox analysis, only previous MI was associated with unfavorable long-term survival (log-rank
p
 = 0.012), while an abnormal electrocardiogram, LVEF, and other clinical variables were not (log-rank
p
 > 0.05, for all). Kaplan–Meier analysis revealed unfavorable long-term survival in patients with CSF and a history of previous MI.
Conclusion
In patients with CSF and an otherwise normal coronary angiogram, a history of a previous MI is associated with unfavorable long-term outcomes.