Cardiac pain atrest Managementandfollow-up ofIOOconsecutive cases

SUMMARY Onehundred consecutive patients, admitted tothecoronary careunitwithcardiac pain atrestbutno evidence ofrecentmyocardial infarction havebeenfollowed up fornine to26(mean14) months. Theywere treated initially withbedrest,beta-adrenergic blockade, andnitrates. In54patients painsubsided within 24hours. Coronary angiography was carried outin46.Thirtyfive hadcoronaryarterylesions andthree hadspasm innormal coronaryarteries. Onehadhypertrophic cardiomyopathy andsevenhadnormal findings. Seventeen patients withprevious angina andsevere coronarydisease were operated on,with one death andone perioperative infarction; two diedlate, 12weresymptomfree, andtwohadangina. Seven of18patients treated medically hadrecurrentangina andunderwent operation. Ofthe11unoperated patients, one died, three hadangina, andseven were symptomfree. Twooftheeight patients whowere notcatheterised developed infarction, fourhad angina, andthree were symptomfree. Recurrent paincontinued for more than24hours in46patients, andallunderwent angiography. Forty-three hadcoronaryarterydisease and34underwent early bypass surgery;there were twooperative deaths andthree perioperative infarctions. Twenty-six were symptomfree atfollow-up. Ofthe nineunoperated patients with coronarydisease, fourdeveloped infarction, twowere operated on for