Chest pain: The prognoses of small vessel disease and vasospastic disease

This paper examined the long-term prognoses of small vessel disease (when the walls of the small arteries in the heart are damaged) and vasospastic disease (contraction of blood vessel). Researchers concluded that both conditions significantly increased mortality risks and the risk of a heart attack.

A coronary angiography is a procedure to detect any blockages in the blood vessels supplying the heart. It is often used to diagnose coronary artery disease, a condition involving a build-up of plaque in the arteries supplying the heart. Some patients can present with chest pain, but show no abnormalities on a coronary angiography. It has been reported that with additional tests over 70% of these patients are diagnosed with a heart condition despite a normal coronary angiography. These conditions often include small vessel disease or vasospastic disease. The long-term prognoses for patients with chest pain and normal coronary angiography is still being investigated.

707 patients with chest pain who underwent coronary angiography as well as additional tests were studied. 40% of patients had small blood vessel disease and 20.1% of patients had vasospasm disease. These patients were combined into one group. 12.2% of patients had another heart condition. 27.7% of patients had no heart condition but likely other problems causing the chest pain.

Patients were followed-up for an average of 11.3 years. 9.6% of patients died during the study period.

Patients with other heart diseases showed no significant differences in mortality rates from heart-related causes and risk of heart attack compared to patients with no heart disease. Mortality risk from heart-related causes and risk of a heart attack increased 4.5-fold for patients with small vessel or vasospastic disease.

Endothelial dysfunction (the reduced function of the inner lining of blood vessels) was examined. Among patients with small vessel disease, those with endothelial dysfunction had a 7.3-fold increased mortality risk from heart-related causes and risk of a heart attack compared to those without endothelial dysfunction.

During the follow-up period, chest pain disappeared in 64% of patients with small vessel disease, 59.9% of patients with vasospastic disease, 68.6% of patients with other heart disease, and in 77% of those with no heart disease. 

The authors concluded that patients with small vessel disease or vasospasm disease were at increased risk of dying from heart related causes or have a non-fatal heart attack. This was particularly pronounced for patients who also had endothelial dysfunction. 

The calculations on mortality risk were based on only 68 patients that died during the study period. Larger studies are therefore needed to confirm these findings.