“Nonspecific” chest pain associated with high long‐term mortality: Results from the primary prevention study in göteborg, sweden

Abstract

Background:The syndrome angina pectoris with effort-related chest pain or discomfort is usually easy to recognize. However, vague and nonspecific symptoms may cause little reason for extensive evaluation. The prognosis of such patients in the general population has so far not been well described.Hypothesis: The study was undertaken to investigate longterm prognosis in men with chest pain considered to be nonspecific in comparison with men with typical angina pectoris (AP) or prior myocardial infarction (MI), and men without chest pain.Methods: At the second screening of the Goteborg Primary Prevention Study in [1974][1975][1976][1977]6,488 men aged 51 to 59 years at baseline were available for the present analysis. Men who had responded positively to a postal questionnaire about chest pain during exercise or at rest were interviewed by a physician according to a Rose questionnaire at the screening examination. Those with typical or probable AP were further examined by a single experienced physician. The following four groups were formed: Group 1: men who did not complain of chest pain (n = 5,545). Group 2: men who had not consulted any doctor because of chest pain, but who had chest pain according to a questionnaire (n = 441); these men were not considered to have AP according to a three-step examination by expenenced physicians. Group 3: typical AP (n = 232).Group 4: men who had suffered an MI (n = 134). Results: During 16 years of follow-up, coronary heart disease (CHD) mortality forGroups 1 4 was 8.0,19.5,24.8, and 48.5%, respectively. Mortality from all cardiovascular diseases was 1 1.5,24.5,3 1.2, and 59.0% respectively. Noncardiovasculardisease mortality was 14.1,17.7,14.3, and 8.7%, respectively. Thus, the relative risk (RR) for CHD mortality among men with nonspecific chest pain (Group 2) was 2.77 [95% confidence interval (CI) 2.20,3.50], for all cardiovascular disease mortality 2.46 (95% CI 2.00,3.02), and for noncardiovascular disease mortality I .60 (95% CI 1.28, 2.00). Total mortality in this group was as high (44%) as among those with typical AP (45%), but the highest mortality was found among men with a previous MI (68%). In men without chest pain it was 26%. Patients of Groups 2 4 had higher levels of cardiovascular risk factors than those in Group 1. Neither any specific questions in the Rose questionnaire, nor electrocardiographic changes at rest (uncommon) were of prognostic significance. Serum cholesterol, systolic blood pressure, diabetes, and smoking were significant predictors of outcome, both with respect to fatal CHD and to total mortality during the 16-year follow-up. Conclusion:We found a high cardiovascular as well as noncardiovascular mortality among patients with chest pain who had not been considered to have AP at a three-step examination procedure. It is important to be suspicious of early CHD symptoms in men (and women?) with "nonspecific" chest symptoms and to analyze their cardiovascular risk factor pattern further because they are at considerably higher risk for future events t...

Chest pain without established ischaemic heart disease in primary care patients: associated comorbidities and mortality

“…Furthermore, it was found that 1-year mortality was higher for patients with non-specific chest pain than for controls. This increased risk of death was consistent with previous findings, 14 and was mainly due to IHDand cancer-related deaths.…”

A 1-year follow-up study of chest-pain patients with and without panic disorder

“…One of these studies concerned men with "possible angina", which was detected using the World Health Organization's Angina Questionnaire, and normal exercise test (20). The other concerned men with non-specific chest pain that was not considered typical of angina (21). Both studies reported a significantly greater incidence of cardiovascular mortality in patients with chest pain than in those with no symptoms of angina after 26 and 16 years respectively (RR 1.97-2.46).…”

Noncardiac chest pain: systematic review of the literature on prognosis

“…The question is how many of these patients eventually develop cardiovascular morbidity and mortality. [9][10][11][12][13] Unexplained chest pain is often comorbid with anxiety, depression, and somatoform disorders. [14][15][16][17][18][19][20][21] In a recent study by White et al, the comorbidity of psychiatric conditions and NCCP was examined prospectively in a cohort of 231 NCCP patients free of a current or lifetime cardiac diagnosis.…”