Angina Pectoris: Prognosis

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The prognosis of angina pectoris has improved with advances in the understanding of its pathophysiology and in pharmacologic therapy. Mortality rates vary depending on the number of vessels diseased, the severity of obstruction, the status of left ventricular function, and the presence of complex arrhythmias. In patients with stable symptoms and normal ejection fractions (> 55%, depending on the laboratory), the mortality rate is 1-2% per year. However, the outlook in individual patients is unpredictable, and nearly half of the deaths are sudden. Therefore, risk stratification is often attempted. Patients with accelerating symptoms have a poorer outlook. Among stable patients, those whose exercise tolerance is severely limited by ischemia (less than 6 minutes on the Bruce treadmill protocol) and those with extensive ischemia by exercise electrocardiography or scintigraphy have more severe anatomic disease and a poorer prognosis.

Fihn SD et al: Guidelines for the management of patients with chronic stable angina: treatment. Ann Intern Med 2001; 135:616.
Gibbons RJ et al: ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina). J Am Coll Cardiol 1999;33:2092.

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