Abstract 15853: Long-Term Outcomes of Young Patients With Chest Pain and Normal Epicardial Coronary Arteries: A 10-Year Prospective Study

• Published in: Circulation (New York, N.Y.) Vol. 148; no. Suppl_1
• Main Authors: Naderian, Mohammadreza, Saadatagah, Seyedmohammad, Ramandi, Alireza, Alipasandi, Kian, Pourhosseini, Hamidreza, sadeghian, saeed
• Format: Journal Article
• Language: English
• Published: 07-11-2023
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.148.suppl_1.15853

Abstract only
Introduction:
Long-term outcomes of young patients with chest pain and normal epicardial coronary arteries (NECA) in angiography remain understudied.
Methods:
We conducted a prospective study in a tertiary heart hospital between 2004-2020, enrolling men<45 and women<55 years presenting with symptoms or objective findings of coronary artery disease (CAD) and confirmed NECA in angiography. Patients with cardiomyopathy, coronary anomaly, and significant valvular, renal, pulmonary, or liver diseases were excluded. The primary outcome was MACCE, defined as the composite of death, CCU admission (for MI or unstable angina), stroke, and revascularization. Follow-ups were done every 5 years using a standardized questionnaire and a committee of experts reviewed all the events. Expected age and sex-adjusted mortality rates were estimated using national data. The association between exposures and MACCE was studied using multivariable Cox-proportional hazard models.
Results:
1257 patients, 340 (27.05%) men (38.34±5.46 years), and 917 (72.95%) women (48.41±4.94 years) were included. 698 (55.53%) had acute and 559 (44.47%) had chronic symptoms. Over the median 9.4 (8.5-11.0) years of follow-up, 134 (10.66%) events happened. CCU admission (6.33%) was the most common event (Figure). The 10-year mortality rate (per 100,000-person-years) was 265 for men and 174 for women, which were 1.6 and 2.5 times higher than the age-sex-matched rate of the normal population, respectively. Diabetes, hypertension, and presenting with acute symptoms were associated with higher MACCE with the hazard ratios (95% CI) of 1.87 (1.05-3.31, P:0.03), 1.72 (1.13-2.61, P:0.01), and 1.56 (1.03-2.36, P:0.04), respectively. During follow-up, 192 (15.27%) repeated angiographies were done and 19.8% developed obstructive CAD.
Conclusions:
In young patients with chest pain and NECA, approximately 10% experienced MACCE during a 10-year follow-up, and the mortality is higher than expected.