The incidence of cardiac events in patients with variant angina pectoris without significant coronary stenosis and ST-segment elevation was analyzed during a 12-year follow-up period in 273 consecutive patients (82% men) admitted from 1986 through 2010. Among the 252 patients who underwent electrocardiography during pain, 205 had ST-segment elevation (82%) and 45 had ST-segment depression (18%). During index hospitalization, angina occurred in 179 patients (66%), ventricular tachycardia or fibrillation in 28 (10%), and complete atrioventricular block in 3 (1%), but there were no deaths or myocardial infarctions (MIs). At 140 months, angina was still present in 129 patients (47%), but frequent angina (>10 episodes/year) occurred in only 6%. Total mortality, cardiac mortality, and MI rates were 24%, 7.0%, and 6%, respectively. Cardiac death or MI occurred in 28 patients (10%), associated with tobacco smoking (p = 0.004), antecedent “first-wind” angina (p = 0.020), and angina during hospitalization (p = 0.044) and with continued smoking (p = 0.056) and recurrent angina during follow-up (p <0.001). Multivariate analysis identified age (p = 0.001), antecedent infarction (p = 0.005), first-wind angina (p = 0.009), and smoking at index hospitalization (p = 0.027) as predictors of total mortality and treatment with calcium antagonists (p = 0.047) and smoking during follow-up (p = 0.110) for cardiac mortality and MI. In conclusion, during 12-year follow-up, patients with variant angina pectoris, mostly with ST-segment elevation during pain, had a reduced incidence of cardiac mortality and MI, associated with first-wind angina, persistent angina, and continued smoking.
Variant angina pectoris (VAP) is the term that identifies angina at rest associated mostly with ST-segment elevation in patients with or without significant coronary stenosis that is caused by coronary vasospasm. These patients may develop serious cardiac events such as myocardial infarction (MI) or sudden cardiac death, often ascribable to ventricular arrhythmias. Patients with significant coronary stenosis, however, present more in-hospital and follow-up events than those without, in part because their substrate is not always distinguishable from that of acute coronary syndromes with complicated plaques and transient coronary thrombosis. The long-term prognosis of patients with nonsignificant coronary stenosis is unsettled, however, because most existing studies have also included patients with significant coronary stenosis. To date, only 2 series have investigated follow-up events in patients without significant coronary stenosis, 1 in 59 patients during 48 months but including an exceedingly high prevalence of women (54%), and the other in 277 patients during 89 months but with a low rate of ST-segment elevation (56%). Thus, we prospectively analyzed patients with VAP and nonsignificant coronary stenosis (<50%) over a 30-year span to identify the course of anginal symptoms and the rates of total and cardiac mortality and MI.
Methods
Consecutive patients with typical angina occurring at rest and without significant coronary stenosis (<50%) (n = 273) who were admitted to our cardiology department from January 1980 through September 2010 and who presented either severe coronary vasospasm during coronary angiography and/or transient ST-segment changes during pain (all without evidence of acute MI) were included in this study. Those with valvular heart disease or previous coronary revascularization procedures were excluded. Information about the circadian rhythm of spontaneous angina was categorized as (1) early-morning angina, during the 3 hours preceding awakening; (2) diurnal angina, from 1 hour after awakening until 7 pm ; (3) evening angina, from 7 to 11 pm ; and (d) nocturnal angina, during the first 5 hours after going to bed. Also, “first-wind” angina was identified as angina occurring during the first exercise after awakening that would not reappear later at a similar or greater exercise load. Patients with Raynaud syndrome (intense cutaneous vasoconstriction of the upper extremities with paleness and pain with contact with cold air or water) were also identified. The response to sublingual nitroglycerin was categorized according to the time to initial pain relief in most episodes: (1) <5 minutes, (2) 5 to 10 minutes, (3) 10 to 20 minutes, and (4) >20 minutes.
Coronary angiography was performed during the index hospitalization, and results were assessed by visual estimation by 2 observers unaware of the patient’s condition. Initially, a provocation test for coronary vasoconstriction was performed at the bedside under electrocardiographic monitoring in 120 patients using intravenous ergonovine (0.1 mg in 2-minute intervals, up to 0.85 mg). This test was later performed during coronary angiography in 94 patients, some of whom had also undergone the bedside test, and it was progressively substituted by the administration of intracoronary acetylcholine (20, 50, and 100 μg in 2-minute intervals) in 57 other patients. Thus, provocative tests were carried out in 165 patients, and 37 others did not undergo vasoconstrictor tests, because of the occurrence of spontaneous catheter-unrelated severe coronary spasm. Drug-induced or spontaneous coronary spasm was deemed to have occurred when the luminal diameter at the culprit artery became totally occluded or reduced to >80%.
Exercise stress testing (mostly using a treadmill) was performed in 215 unselected patients, and the maximal heart rate attained, development of chest pain, and electrocardiographic changes were recorded. Positive results were defined by a flat ST-segment depression ≥1.0 mm in ≥2 leads. Myocardial scintigraphic stress testing was performed in 142 also unselected patients, and myocardial ischemia was categorized as mild when it involved 1 or 2 segments with nontransmural defects, moderate when it involved ≥2 segments also with nontransmural defects, or severe when it involved ≥2 segments with transmural defects.
During the index hospitalization, once the diagnostic of VAP was made, and also during follow-up, medical treatment included mainly nitrates and calcium antagonists, whereas the use of aspirin was left to the discretion of the attending physician. In patients with frequent episodes of angina despite full medical treatment, repeat coronary angiography was often proposed. Most patients were followed in the outpatient clinic for ≥5 years, and at the end of follow-up, patients’ condition was assessed in the clinic for 197 (72%) and by telephone for the rest. MI was diagnosed by the presence of anginal pain lasting >30 minutes refractory to sublingual nitroglycerin, and in case of hospitalization, electrocardiographic changes and/or enzyme increases were required. Death was considered of cardiac origin if it followed heart failure, arrhythmias, MI, or coronary revascularization. The protocol was approved by the hospital ethics committee, and informed consent was obtained before entering the study.
Descriptive data are presented as mean ± SD or as proportions for individual characteristics. Chi-square and Fisher’s exact tests were used to compare categorical variables, whereas analysis of variance was used for continuous variables with normal distributions, with post hoc analysis with Bonferroni’s correction, and Kruskal-Wallis tests for continuous variables with abnormal distributions. To explore the association between the variables of interest and the outcome events of total mortality and cardiac mortality or MI during follow-up, we used survival analysis, with patients censored at the time of the first event. We used Cox regression modeling. We first analyzed the bivariate associations estimating the crude hazard ratio of total mortality and cardiac mortality or MI for each variable of interest. Those variables with p values <0.20 in the log-rank test were considered candidates for entry into the model. The initial model was obtained using a backward and forward stepwise method with a threshold for exit set at p >0.05. Once the initial variables were selected, the other variables were each included 1 by 1, and they were retained in the model only when they induced a substantial change in the coefficients or if they were considered clinically relevant. The objective was to build a parsimonious predictive model. The proportional-hazards assumption was tested for each variable using plots of log(time) versus log[−log(survival)] stratified by the variable. Survival was estimated using the Kaplan-Meier method.
Results
As relevant data in the clinical profile of these patients ( Table 1 ), there was a clear predominance of male gender, a high incidence of smoking, and a low incidence of diabetes mellitus. Also, Raynaud syndrome was present in 13 patients (10 men and 3 women), and nocturnal and early-morning angina were frequent. In fact, either or both were present in 213 patients (91%). Among the 252 patients who underwent electrocardiography during spontaneous angina or during an angiographically documented coronary vasospasm, 2 showed no electrocardiographic changes, 205 (82%) had ST-segment elevation (187 with ST-segment elevation alone and 18 with minimum ST-segment elevation and transient tall T waves), and 45 had ST-segment depression ( Table 1 ). Treadmill exercise test results were positive in 35% (76 of 215), whereas moderate to severe myocardial ischemia occurred during scintigraphic stress testing in 29% (41 of 142).
| Variable | n | Total Mortality | Cardiac Mortality or MI | |||||
|---|---|---|---|---|---|---|---|---|
| Global (n = 273) | Yes (n = 62) | No (n = 211) | p Value | Yes (n = 28) | No (n = 245) | p Value | ||
| Age (years), mean ± SD | 273 | 54 ± 11 | 56.4 ± 11 | 52 ± 10 | 0.005 | 52 ± 11 | 53 ± 11 | 0.70 |
| Women | 273 | 50 (18%) | 11 (18%) | 39 (19%) | 0.8 | 1 (4%) | 49 (20%) | 0.033 |
| Hypertension | 270 | 87 (32%) | 18 (29%) | 69 (33%) | 0.54 | 11 (39%) | 76 (31%) | 0.40 |
| Diabetes mellitus | 273 | 12 (4%) | 1 (2%) | 11 (5%) | 0.31 | 1 (4%) | 11 (5%) | 1.00 |
| Tobacco smoking | 270 | 0.028 | 0.042 | |||||
| No | 68 (25%) | 13 (21%) | 55 (26%) | 5 (18%) | 63 (26%) | |||
| Active | 181 (67%) | 48 (77%) | 163 (64%) | 23 (82%) | 158 (65%) | |||
| Previous | 21 (8%) | 1 (2%) | 20 (10%) | 0 | 21 (9%) | |||
| Chronic obstructive pulmonary disease | 268 | 61 (23%) | 22 (36%) | 39 (19%) | 0.005 | 10 (36%) | 51 (21%) | 0.08 |
| Total cholesterol >230 mg/dl | 259 | 144 (56%) | 31 (53%) | 113 (57%) | 0.6 | 18 (64%) | 126 (55%) | 0.33 |
| Peripheral vascular disease | 267 | 25 (9%) | 10 (16%) | 15 (7%) | 0.032 | 5 (18%) | 20 (8%) | 0.18 |
| Cerebrovascular accident | 262 | 9 (3%) | 2 (3%) | 7 (4%) | 1 | 0 | 9 (3.8%) | 0.60 |
| Hiatal hernia | 233 | 40 (17%) | 8 (18%) | 32 (17%) | 0.84 | 2 (9%) | 38 (18%) | 0.38 |
| Gastrointestinal ulcer | 236 | 62 (26%) | 11 (23%) | 51 (27%) | 0.62 | 6 (27%) | 56 (26%) | 0.91 |
| Previous MI | 267 | 10 (4%) | 5 (8%) | 5 (2%) | 0.049 | 1 (4%) | 9 (4%) | 1.00 |
| Exercise angina | 270 | 141 (52%) | 31 (50%) | 110 (53%) | 0.69 | 19 (68%) | 122 (50%) | 0.08 |
| Months | 134 | 20.6 (37) | 18 (30) | 31 (54) | 0.21 | 24 (37) | 20 (37) | 0.65 |
| Rest angina | 270 | 233 (86%) | 55 (89%) | 178 (86%) | 0.67 | 25 (89%) | 208 (86%) | 0.44 |
| Months | 233 | 21.7 (37) | 26 (41) | 20 (35) | 0.38 | 20 (39) | 22 (36) | 0.83 |
| Typical angina | 269 | 261 (97%) | 55 (90%) | 206 (99%) | 0.002 | 26 (93%) | 235 (98%) | 0.20 |
| Type of angina | 270 | 0.023 | 0.02 | |||||
| Silent ischemia | 8 (3%) | 5 (8%) | 3 (1%) | 2 (7%) | 6 (3%) | |||
| Rest | 162 (60%) | 37 (60%) | 125 (60%) | 13 (46%) | 149 (62%) | |||
| Exercise | 37 (14%) | 4 (7%) | 33 (16%) | 1 (4%) | 36 (15%) | |||
| Mixed | 63 (23%) | 16 (26%) | 47 (23%) | 12 (43%) | 51 (21%) | |||
| Early-morning angina pectoris | 262 | 176 (67%) | 37 (64%) | 139 (68%) | 0.53 | 21 (75%) | 155 (66%) | 0.35 |
| Diurnal angina pectoris | 265 | 140 (53%) | 32 (53%) | 108 (53%) | 0.93 | 15 (58%) | 125 (52%) | 0.60 |
| Evening angina pectoris | 256 | 137 (54%) | 30 (56%) | 107 (53%) | 0.73 | 11 (50%) | 126 (54%) | 0.73 |
| Nocturnal angina pectoris | 262 | 130 (50%) | 31 (52%) | 99 (49%) | 0.72 | 15 (58%) | 115 (49%) | 0.39 |
| Emotional angina pectoris | 233 | 73 (31%) | 14 (28%) | 59 (32%) | 0.29 | 7 (30%) | 66 (31%) | 0.92 |
| First-wind angina pectoris | 246 | 40 (16%) | 8 (15%) | 32 (17%) | 0.89 | 9 (35%) | 31 (14%) | 0.02 |
| Nitroglycerin response >5 minutes | 270 | 38 (14%) | 7 (12%) | 31 (15%) | 0.54 | 4 (14%) | 34 (14%) | 0.97 |
| Raynaud phenomenon | 273 | 13 (5%) | 3 (5%) | 10 (5%) | 1 | 2 (8%) | 11 (5%) | 0.36 |
| Angina during index hospitalization | 268 | 174 (65%) | 47 (78%) | 127 (61%) | 0.013 | 23 (82%) | 151 (63%) | 0.044 |
| Baseline electrocardiographic findings | 0.094 | 0.11 | ||||||
| Normal | 158 (63%) | 27 (49%) | 131 (65%) | 15 (54%) | 143 (63%) | |||
| ST-T changes | 46 (18%) | 13 (24%) | 33 (16%) | 9 (32%) | 37 (16%) | |||
| Other | 52 (20%) | 15 (27%) | 37 (18%) | 4 (14%) | 48 (21%) | |||
| Electrocardiographic changes during angina | 250 | 0.51 | 0.43 | |||||
| ST-segment elevation ST or positive T waves | 205 (82%) | 50 (85%) | 155 (81%) | 23 (89%) | 182 (81%) | |||
| ST depression | 45 (18%) | 9 (15%) | 36 (19%) | 3 (12%) | 42 (19%) | |||
| Site of ST-segment elevation | 185 | 0.29 | 0.09 | |||||
| Anterior | 86 (47%) | 27 (56%) | 59 (43%) | 14 (67%) | 71 (44%) | |||
| Inferior | 94 (51%) | 20 (42%) | 74 (54%) | 7 (33%) | 87 (53%) | |||
| Lateral | 5 (3%) | 1 (2%) | 4 (3%) | 0 | 5 (3%) | |||
| Maximum ST-segment elevation (mm) | 182 | 0.45 | 0.27 | |||||
| ≤2 | 66 (33%) | 14 (30%) | 52 (39%) | 4 (20%) | 61 (38%) | |||
| 2–5 | 83 (46%) | 25 (53%) | 58 (43%) | 12 (60%) | 71 (44%) | |||
| >5 | 33 (18%) | 8 (17%) | 25 (19%) | 4 (20%) | 29 (18%) | |||
Smooth coronary arteries or lesions ≤30% were present in 183 patients (67%), and severe coronary spasm was documented in 116. Some provocative tests did not cause severe spasm, largely because antianginal treatment was not withhold before angiography because ST-segment elevation had been previously documented during spontaneous angina. Ejection fractions were normal, 71 ± 10.5%, and were <50% in only 5 patients (1.8%).
During the index hospitalization, angina recurred in 179 patients (66%), and serious arrhythmias occurred in 31 patients (11.4%): ventricular fibrillation in 14 (5.1%), ventricular tachycardia in 14 (5.1%), and complete atrioventricular block in 3 (1.1%). The occurrence of ventricular fibrillation or ventricular tachycardia was higher in patients with striking ST-segment elevation during angina than in the remainder (≥5.0 mm in 11 of 33 [30%] vs <5.0 mm in 17 of 170 [10%], p = 0.001). There were no deaths or MIs.
During the 12-year follow-up period (140 months, 25th and 75th percentiles 73.2 and 204), angina, mostly spontaneous, was not an infrequent finding, but frequent angina (>10 episodes/year) occurred in only 6% ( Table 2 ). Angina presented more often in patients with antecedent angina at index hospitalization (116 of 227 [51.1%]) than in those without (14 of 46 [30%]) (p = 0.015). All but 1 patient with Raynaud syndrome continued to have angina, which was frequent in 8 (62%). Moreover, the use of aspirin did not result in an apparent increase in the occurrence of angina (73 of 163 [45%] vs 54 of 110 [49%], p = 0.326) or in the presence of ≥5 episodes/year (35 of 163 [22%] vs 21 of 110 [19%], p = 0.651).
| Variable | n | Total Mortality | Cardiac Mortality or MI | |||||
|---|---|---|---|---|---|---|---|---|
| Global (n = 273) | Yes (n = 62) | No (n = 211) | p Value | Yes (n = 28) | No (n = 245) | p Value | ||
| Follow-up treatment | ||||||||
| β blockers | 261 | 37 (14%) | 4 (7%) | 33 (16%) | 0.09 | 3 (12%) | 34 (15%) | 1 |
| Nitrates | 263 | 126 (48%) | 35 (61%) | 91 (44%) | 0.021 | 15 (58%) | 111 (47%) | 0.29 |
| Calcium antagonists | 264 | 174 (66%) | 44 (76%) | 130 (63%) | 0.07 | 21 (81%) | 153 (64%) | 0.13 |
| Aspirin | 259 | 162 (63%) | 31 (56%) | 131 (64%) | 0.29 | 17 (65%) | 145 (62%) | 0.75 |
| Angiotensin-converting enzyme inhibitors | 260 | 38 (15%) | 4 (7%) | 34 (17%) | 0.07 | 3 (12%) | 35 (15%) | 0.78 |
| Statins | 258 | 89 (35%) | 11 (20%) | 78 (38%) | 0.014 | 9 (38%) | 80 (34%) | 0.74 |
| Follow-up tobacco smoking | 224 | 52 (23%) | 13 (29%) | 39 (22%) | 0.32 | 8 (38%) | 44 (22%) | 0.10 |
| Follow-up angina episodes | 268 | 0.46 | 0.003 | |||||
| None | 143 (53%) | 25 (45%) | 118 (56%) | 5 (20%) | 138 (57%) | |||
| 2–5 | 69 (26%) | 18 (32%) | 51 (24%) | 12 (48%) | 57 (24%) | |||
| 5–10 | 42 (15%) | 9 (16%) | 33 (16%) | 7 (28%) | 35 (14%) | |||
| >10 | 14 (5%) | 4 (7%) | 10 (5%) | 1 (4%) | 13 (5%) | |||
| Follow-up angina ≥1 episode | 268 | 125 (47%) | 31 (55%) | 94 (44%) | 0.14 | 20 (80%) | 105 (43%) | <0.001 |
| Repeated coronary angiography | 273 | 59 (22%) | 13 (21%) | 46 (22%) | 0.95 | 11 (42%) | 47 (19%) | 0.006 |
| Significant coronary stenosis | 59 | 18 (31%) | 6 (50%) | 12 (26%) | 0.16 | 8 (67%) | 10 (21%) | 0.004 |
| Coronary revascularization | 273 | 21 (8%) | 7 (12%) | 14 (7%) | 0.27 | 6 (23%) | 14 (6%) | 0.007 |
| Percutaneous coronary intervention | 264 | 12 (5%) | 4 (7%) | 8 (4%) | 0.3 | 2 (9%) | 10 (4%) | 0.28 |
| Coronary artery bypass grafting | 272 | 8 (3%) | 2 (3%) | 6 (3%) | 0.84 | 4 (15%) | 4 (2%) | 0.004 |
Mortality was mostly noncardiac. In 7 patients (11.3%), however, the cause of death could not be determined, although all survived for at least the first 7 years ( Table 2 ). Total mortality was associated with age, tobacco smoking (at baseline and during follow-up), chronic obstructive pulmonary disease, previous MI, angina during the index hospitalization, and angina during treadmill testing. It was also associated with angina and treatment with nitrates and calcium antagonists at the end of follow-up ( Tables 1 to 3 , Figure 1 ). Independent predictors of mortality were age, previous MI, and tobacco smoking at the end of follow-up ( Table 4 ).
| Variable | Total Mortality (n = 62) | Cardiac Death (n = 21) | MI (n = 15) | Cardiac Death or MI (n = 29) | ||||
|---|---|---|---|---|---|---|---|---|
| HR (95% CI) | p Value | HR (95% CI) | p Value | HR (95% CI) | p Value | HR (95% CI) | p Value | |
| Age (years) (×10) | 1.63 (1.27–2.1) | <0.001 | 1.31 (0.87–1.97) | 0.2 | 0.74 (0.44–1.2) | 0.25 | 1.03 (0.72–1.47) | 0.89 |
| Female gender | 1.05 (0.56–2) | 0.8 | 0.24 (0.03–1.78) | 0.16 | 0.04 (0–11) | 0.26 | 0.17 (0.023–1.2) | 0.081 |
| Tobacco smoking | 0.004 | |||||||
| No | Reference | |||||||
| Active | 1.32 (0.7–2.4) | 0.38 | 1.54 (0.5–4.6) | 0.43 | 2.2 (0.5–9.8) | 0.3 | 1.6 (0.6–4.3) | 0.32 |
| Past | 0.35 (0.04–2.7) | 0.32 | Not estimated | Not estimated | Not estimated | |||
| Chronic obstructive pulmonary disease | 1.81 (1.07–3) | 0.027 | 2.43 (1.03–5.8) | 0.043 | 2.02 (0.7–5.7) | 0.18 | 1.75 (0.81–3.8) | 0.16 |
| Peripheral vascular disease | 1.67 (0.85–3.3) | 0.139 | 2.12 (0.71–6.3) | 0.18 | 2.13 (0.6–7.6) | 0.24 | 1.88 (0.7–4.9) | 0.2 |
| Previous MI | 3.34 (1.3–8.3) | 0.01 | 1.7 (0.2–12.6) | 0.61 | 0.05 (0–216) | 0.64 | 1.15 (0.16–8.5) | 0.89 |
| In-hospital angina | 2.12 (1.1–3.9) | 0.016 | 3.38 (1–11.5) | 0.05 | 1.5 (0.48–4.8) | 0.48 | 2.58 (0.98–6.8) | 0.055 |
| Exercise angina | 0.8 (0.47–1.39) | 0.8 | 0.95 (0.35–2.6) | 0.91 | 3.4 (1.12–10) | 0.024 | 1.5 (0.7–3.2) | 0.3 |
| Onset of exercise angina | ||||||||
| No angina | Reference | Reference | Reference | Reference | ||||
| ≤3 months | 0.53 (0.26–1.06) | 0.074 | 1.21 (0.38–3.8) | 0.75 | 3.6 (0.9–14.2) | 0.064 | 1.86 (0.71–4.86) | 0.2 |
| >3 months | 1 (0.57–1.8) | 0.97 | 1.16 (0.37–3.7) | 0.79 | 2.8 (0.7–11.9) | 0.15 | 1.9 (0.74–5) | 0.18 |
| Early-morning angina | 0.68 (0.4–1.17) | 0.16 | 0.83 (0.33–2.1) | 0.69 | 1.11 (0.35–3.5) | 0.86 | 1.25 (0.5–2.9) | 0.61 |
| Evening angina | 1 (0.59–1.7) | 0.99 | 1.04 (0.39–2.8) | 0.94 | 0.27 (0.07–0.98) | 0.047 | 0.8 (0.35–1.85) | 0.6 |
| First-wind angina | 0.87 (0.41–1.84) | 0.71 | 2.7 (1.06–6.9) | 0.037 | 2.98 (0.97–9.1) | 0.056 | 2.6 (1.17–5.9) | 0.02 |
| Normal baseline electrocardiographic results | 0.56 (0.3–0.93) | 0.026 | 0.53 (0.22–1.25) | 0.14 | 1.1 (0.38–3.2) | 0.86 | 0.66 (0.32–1.4) | 0.28 |
| Maximum ST-segment elevation during angina (mm) | ||||||||
| ≤2 | Reference | Reference | Reference | Reference | ||||
| 2–5 | 1.6 (0.8–3.2) | 0.15 | 4.1 (0.1–18.9) | 0.07 | 1.69 (0.42–6.78) | 1.69 | 2.5 (0.82–7.8) | 0.11 |
| >5 | 1.4 (0.58–3.3) | 0.46 | 3.27 (0.55–19.6) | 0.19 | 0.73 (0.08–7) | 0.78 | 2.1 (0.53–8.6) | 0.28 |
| Angina during treadmill stress test | 1.85 (1.02–3.4) | 0.043 | 3.35 (1.2–9) | 0.017 | 1.5 (0.52–4.3) | 0.45 | 1.6 (0.68–3.8) | 0.27 |
| Maximum heart rate (×10) | 0.83 (0.73–0.95) | 0.009 | 0.83 (0.66–1.05) | 0.12 | 1.19 (0.92–1.5) | 0.18 | 0.91 (0.75–1.1) | 0.36 |
| Moderate to severe ischemia during myocardial scintigraphic stress test | 1.5 (0.61–3.69) | 0.37 | 5.87 (1.1–32.3) | 0.042 | 0.67 (0.1–5.8) | 0.72 | 2.26 (0.71–7.2) | 0.17 |
| Maximum heart rate during myocardial scintigraphic stress test (×10) | 0.98 (0.95–1.02) | 0.29 | 0.7 (0.49–1.01) | 0.06 | 1.2 (0.76–1.9) | 0.43 | 0.78 (0.57–1.07) | 0.66 |
| Ejection fraction (×10) | 0.83 (0.65–1.06) | 0.14 | 1.3 (0.81–2.1) | 0.28 | 0.86 (0.52–1.4) | 0.54 | 1.04 (0.7–1.5) | 0.86 |
| Nitrates during follow-up | 2.7 (1.5–4.6) | <0.001 | 2.28 (1.07–7.2) | 0.035 | 0.65 (0.2–2) | 0.45 | 2 (0.93–4.5) | 0.07 |
| Calcium antagonists during follow-up | 2 (1.1–3.7) | 0.02 | 2.36 (0.78–7.1) | 0.13 | 1.6 (0.5–5.2) | 0.4 | 2.7 (1.01–7.1) | 0.048 |
| Follow-up tobacco smoking | 1.2 (0.6–2.3) | 0.54 | 1.4 (0.4–4.6) | 0.57 | 3.77 (1.26–11.2) | 0.017 | 1.97 (0.8–4.77) | 0.13 |
| Follow-up angina episodes | ||||||||
| None | Reference | Reference | Reference | Reference | ||||
| 2–5 | 1.2 (0.68–2.3) | 0.46 | 4.9 (1.3–18.4) | 0.019 | 4.8 (1.3–18) | 0.021 | 4.4 (1.5–12.5) | 0.05 |
| 5–10 | 1.08 (0.51–2.3) | 0.83 | 4.1 (0.92–18.3) | 0.065 | 3.2 (0.64–15.8) | 1.55 | 4.5 (1.4–14.1) | 0.01 |
| >10 | 1.85 (0.64–5.3) | 0.25 | 3.46 (0.36–33.3) | 0.28 | Not estimated | 2.2 (0.25–18.7) | 0.48 | |
| Follow-up angina ≥1 episode | 1.2 (0.64–2.1) | 0.41 | 4.48 (1.27–15.7) | 0.019 | 3.8 (1.06–13.7) | 0.04 | 4.2 (1.6–11.26) | 0.004 |
| Raynaud phenomenon | 0.78 (0.24–2.5) | 0.68 | 0.95 (0.12–7.2) | 0.96 | 1.2 (0.16–9.3) | 0.85 | 1.37 (0.3–5.8) | 0.66 |
| Repeat coronary angiography | 0.59 (0.31–1.12) | 0.11 | 1.16 (0.41–3.3) | 0.77 | 4.2 (1.47–12) | 0.007 | 2.1 (0.98–4.7) | 0.057 |
| Coronary revascularization | 0.8 (0.35–1.9) | 0.64 | 1.2 (0.27–5.3) | 0.8 | 4.6 (1.5–13.8) | 0.006 | 2.9 (1.2–7.4) | 0.023 |
| Percutaneous coronary intervention | 1.2 (0.49–3.1) | 0.66 | 2.06 (0.47–9) | 0.33 | 2.3 (0.5–10.3) | 0.28 | 2.1 (0.6–7) | 0.23 |
| Coronary artery bypass grafting | 0.58 (0.14–2.4) | 0.46 | 1.3 (0.17–10) | 0.79 | 5.7 (1.6–20) | 0.008 | 4.39 (1.49–12.9) | 0.007 |
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
