Unexplained chest/epigastric pain in patients with normal endoscopy as a predictor for ischemic heart disease and mortality: A Danish 10-year cohort study

Estrid Muff Munk¹ , Bente Nørgård² , Claus Dethlefsen³ , Hans Gregersen⁴ , Asbjørn Mohr Drewes⁴ , Peter Funch-Jensen⁵ and Henrik Toft Sørensen¹

¹Department of Clinical Epidemiology, Aarhus and Aalborg Hospital, Aarhus, University Hospital, DK-8000 Aarhus C, Denmark

²Department of Clinical Epidemiology, Aarhus University Hospital, DK-8000 Aarhus C, and Department of Applied Research and Health Technology Assessment, Odense University Hospital, DK-5000 Odense C. Denmark

³Center for Cardiovascular Research, Aalborg Hospital, Aarhus University, Hospital, DK-9000 Aalborg, Denmark

⁴Center of Visceral Biomechanics and Pain, Department of Gastroenterology, Aalborg Hospital, Aarhus University Hospital, DK-9000 Aalborg, Denmark

⁵Department of Surgical Gastroenterology L, Aarhus Hospital, Aarhus University, Hospital, DK-8000 Aarhus C, Denmark

author email corresponding author email

BMC Gastroenterology 2008, 8:28doi:10.1186/1471-230X-8-28


Published:	15 July 2008

Abstract

Background

Normal upper endoscopy may be a marker of ischemic heart disease in patients with unexplained chest/epigastric pain.

Methods

We examined the 10-year risk of ischemic heart disease and mortality in a cohort of 386 Danish patients with chest/epigastric pain, normal upper endoscopy, and no prior hospital discharge diagnosis of ischemic heart disease (defined as patients with unexplained chest/epigastric pain), compared with 3,793 population controls matched by age, gender, and residence. Outcome data were obtained from population-based health registries. Cox regression analysis was used to estimate the relative risk of hospitalization for ischemic heart disease and the adjusted mortality rate ratio (MRR).

Results

The 10-year relative risk of hospitalization for ischemic heart disease following a normal upper endoscopy among patients with unexplained chest/epigastric pain was 1.6 (95% CI, 1.1–2.2), compared with controls. The 10-year MRR was 1.1 (95% CI, 0.9–1.5). Within the first year after the upper endoscopy the MRR was 2.4 (95% CI, 1.3–4.5). The cause-specific MRR among patients with unexplained chest/epigastric pain compared with controls was up to threefold higher for deaths related to alcohol dependence, pneumonia, and lung cancer.

Conclusion

Unexplained chest/epigastric pain in patients with normal endoscopy is a strong marker for ischemic heart disease and increased mortality.