Unimproved chest pain in patients with minimal or no coronary disease: A behavioral phenomenon

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Abstract

Patients with chest pain and minimal or no coronary disease have a good prognosis for survival, yet many continue to have pain. In our experience with 821 medically treated patients there were three cardiac deaths (0.3%) and two nonfatal myocardial infarctions (0.2%) in the first year after angiography, which had revealed insignificant (<75% narrowing of the luminal diameter) or no coronary artery stenosis. In a subset of 548 patients selected with no apparent systematic difference from the inception cohort of 821 patients, there was complete absence of chest pain in 178 (33%) patients but 155 (28%) had similar or worse pain. From an analysis of clinical history and catheterization data entered in a stepwise logistic regression function, unimproved chest pain was significantly associated with female sex (p = 0.01) and an index of five chest pain descriptors (p = 0.0005). After adding selected behavioral variables available for a representative sample of 217 patients, a high hypochondriasis score (scale I from the Minnesota Multiphasic Personality Inventory) became the strongest determinant of continued pain (p < 0.0001). In our experience, an exaggerated preoccupation with personal health is prospectively associated with continued chest pain in patients with minimal or no coronary disease.

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This work was supported by Grant HS 03834 from the National Center for Health Services Research and the National Center for Health Care Technology, Hyattsville, Md.; by Research Grants HL-17670 and HL-22740 from the National Heart, Lung and Blood Institute, Bethesda, Md.; by Training Grant LM 07003 and Grant LM 03373 from the National Library of Medicine, Bethesda, Md.; by grants from the Prudential Insurance Company of America, Newark, N.J.; by the Kaiser Family Foundation, Palo Alto, Calif.; by the Andrew W. Mellon Foundation, New York, N.Y.; and by a Canadian Heart Foundation Research Fellowship (Dr. Wielgosz).

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