Excellent prognosis of Japanese patients with chest pain and normal or nearly normal coronary arteries--2- to 13-year follow-up of 274 patients after coronary cineangiography.

Although the prognosis of patients with chest pain and normal coronary arteries is reportedly good in the Western literature, it is unclear in Japan. The purpose of this study was to examine the natural history of 274 consecutive patients with chest pain and normal or nearly normal coronary arteries, and to determine whether the possibility of minor coronary artery disease has clinical implications as a prodromal factor of other heart diseases. Six of the patients died during the mean observation period of 6 years (74.5 +/- 35.4 months): 2 cancer, 3 cerebro-vascular accident, and 1 renal failure death. Three additional patients suffered from nonfatal cerebro-vascular accidents. Eleven patients were readmitted for evaluation of chest pain, and 4 of these were diagnosed as having vasospastic angina. Progression of significant coronary artery disease was not detected in these 11 patients with repeated coronary angiography. None of the patients in this study developed fatal or nonfatal myocardial infarction. A small number of patients (36/240, 15.0%) continued to suffer from chest pain. None of the patients developed cardiomyopathies or valvular heart diseases. Our observations indicate that the prognosis of chest pain with normal or nearly normal coronary arteries is better than that presented in the Western reports.