M. Ishihara et al., IMPLICATIONS OF PRODROMAL ANGINA-PECTORIS IN ANTERIOR WALL ACUTE MYOCARDIAL-INFARCTION - ACUTE ANGIOGRAPHIC FINDINGS AND LONG-TERM PROGNOSIS, Journal of the American College of Cardiology, 30(4), 1997, pp. 970-975
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.