IMPLICATIONS OF PRODROMAL ANGINA-PECTORIS IN ANTERIOR WALL ACUTE MYOCARDIAL-INFARCTION - ACUTE ANGIOGRAPHIC FINDINGS AND LONG-TERM PROGNOSIS

Objectives. This study was undertaken to assess how prodromal angina a ffects long-term prognosis after acute myocardial infarction. Backgrou nd. Although it has been reported that prodromal angina occurring shor tly before the onset of acute myocardial infarction has protective eff ects against ischemia, its implication for long term prognosis remains unclear. Methods. We studied consecutive 350 patients with anterior m yocardial infarction who underwent coronary angiography within 24 h af ter the onset of chest pain. Follow-up was achieved for 340 patients ( 97%). Results. Eighty-nine patients had one or more episodes of angina within 24 h before infarction. On initial angiography, patients with prodromal angina in the 24 h before infarction had a patent infarct-re lated artery more frequently than did those without prodromal angina ( 34% vs. 22%, p = 0.03). Among 213 patients who underwent thrombolytic therapy for an occluded infarct-related artery, reperfusion was more f requently achieved in patients with prodromal angina in the 24 h befor e infarction (76% vs, 56%, p = 0.01). Prodromal angina in the 24 h bef ore infarction was associated with a lower in-hospital mortality rate (6% vs. 14%, p = 0.02) and better 5-year survival (p = 0.009). There w as no significant difference in survival between patients with previou s angina at any time (n = 202) and those without. Multivariate analysi s showed that prodromal angina in the 24 h before infarction was an in dependent factor related to 5-year survival after acute myocardial inf arction (odds ratio 0.49, p = 0.04). Conclusions. Prodromal angina occ urring shortly before the onset of infarction, but not previous angina itself, has a beneficial effect on long-term prognosis after infarcti on, suggesting a relation to ischemic preconditioning. (C) 1997 by the American College of Cardiology.