Refractory angina pectoris carries a favourable prognosis: a three-year follow-up of 150 patients

OBJECTIVE: To investigate the three-year prognosis in refractory angina pectoris.

PATIENTS: Two hundred and forty three patients were screened at six European university hospitals for a gene therapy trial. In 150 patients refractory angina pectoris could be confirmed. Vital status was assessed after a mean of 33 months.

RESULTS: At baseline, mean age was 63+/-9 years and mean LVEF was 52+/-12%. In 61% there was a history of myocardial infarction and 83% had previously been revascularised. Mortality was 5.5% at one year and 13.5% at three years. New revascularisation options were found in 9.5% of the 243 screened patients at baseline coronary angiography. Additionally, in 6% of the trial patients the protocol-specified angiogram after three months revealed new significant stenosis, which was treated by percutaneous intervention.

CONCLUSIONS: Annual mortality in refractory angina pectoris seems higher than in stable angina pectoris in general, but substantially lower than after myocardial infarction. The "refractoriness" of these patients should be re-evaluated regularly, as new revascularisation options often occur.