Angina Pectoris: Prognosis

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.

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