DOSE OCCURRENCE OF CHEST PAIN IN THE CARDIOLOGY CLINIC PREDICT FUTURE CARDIOVASCULAR EVENTS? WHITE COAT ANGINA TRIAL.

Abstract

Back ground/Objective Whether the occurrence of chest pain in cardiology clinic represents a variant of “white-coat hypertension” is unknown. The purpose of this study was to determine the incidence, natural history, and prognostic implications of chest pain observed in a general cardiology clinic. Methods From February 2005 to November 2005, 612 patients, mean age 64 ± 10 years (range 42-87 years), 99% male, were prospectively evaluated in the cardiology clinic. Chest pain was defined as pain occurring while waiting to be seen or in the presence of the clinic physician. Chest pain was defined as typical angina, atypical angina, or noncardiac pain. Cardiac events at follow-up were acute myocardial infarction (AMI), revascularization, hospitalization for cardiac reasons, and cardiac death. Cardiac event rates were compared between the chest pain group and the non-chest pain group by the Fisher exact test. Results Of the 612 patients, 28 (4.6%) had chest pain, of which 10 patients (1.6%) had typical angina. One-way analysis of variance did not show any significant difference in age, gender, heart rate, blood pressure recorded in clinic, and underlying heart disease between the chest pain group and the non-chest pain group. At follow-up, 6 ± 2 months (range 3-10 months), 2 events (7%) occurred in the chest pain group compared with 141 events (24%) in the non-chest pain group (two-sided p value = .09). Conclusion In male patients, the occurrence of chest pain or typical angina is low during cardiology clinic visit (4.6% and 1.6%, respectively). The occurrence of chest pain (typical, atypical, or noncardiac) during clinic visits is independent of clinic blood pressure and heart rate. Occurrence of chest pain in the clinic may represent a variant of white coat hypertension and is not associated with increased risk of cardiac events at short-term follow-up.