Relation and independence of angina pectoris and sudden death in persons with coronary atherosclerotic heart disease.

Angina is an important though relatively insensitive and nonspecific predictor of the presence of significant coronary occlusive disease. If angina is present, there is a high probability of significant coronary atherosclerosis. However, the lack of angina, even with vigorous exertion, does not imply absence of severe and potentially lethal amounts of coronary stenosis because a high percent of patients who have had sudden cardiac arrest or myocardial infarction have not had prior angina pectoris. In many studies that carefully and specifically examined the prognostic importance of angina in relation to other variables, neither the presence of angina nor its severity was of prognostic significance, although a few studies suggested that the unstable form of angina may have unfavorable prognostic significance independent of the state of left ventricular function or the severity of coronary atherosclerosis. Thus, it would not appear to be wise to base individual or national decisions aimed at reducing the likelihood of death from coronary disease primarily on the presence or absence of angina pectoris.