Purpose: To estimate the cumulative incidence of cardiac death in patients with NCCP ascribed a GI diagnosis in comparison to patients with NCCP of unknown origin.
Methods: A previous study identified 2,068 Olmsted County, Minnesota residents presenting to one of the county's three Emergency Departments with acute chest pain between January 1, 1985 and January 31, 1992. From this cohort, 359 patients were dismissed after hospitalization with a diagnosis of NCCP. Of these, 230 patients were labeled as chest pain of unknown origin (NCCP-U), while ninety-four received a gastrointestinal diagnosis (NCCP-GI). The latter 324 patients provide the population of the current study.
A review of the medical record was conducted at the largest of the three medical centers (Mayo Clinic) providing follow-up from January 1, 1993 through January 1, 2006. All deaths were abstracted with particular focus on cardiac death as determined by the clinician's report. Utilizing a competing risks survival analysis, cumulative incidence of cardiac death was calculated for the NCCP-U and NCCP-GI subsets.
Results: In the NCCP-GI group, the cumulative incidence of cardiac death at years one, five, ten, and twenty were 1.1%, 6.9%, 9.3%, and 13.3% respectively. In the NCCP-U group, the cumulative incidence of cardiac death at years one, five, ten, and twenty were 0.5%, 1.9%, 5.8%, 10.5% respectively.
Conclusions: This study suggests an increased cumulative incidence of cardiac death in patients with NCCP. This is significantly different from most previous data on cardiac outcomes in this population. Patients with NCCP due to a GI disorder experienced a slightly higher cumulative incidence of cardiac death than the patients with NCCP of unknown origin, possibly due to overlapping risk factors for GERD and coronary disease including obesity, smoking, obstructive sleep apnea, and diabetes mellitus.
Supported by an unrestricted research grant from Tap.