EARLY AND 6-MONTH OUTCOME IN PATIENTS WITH ANGINA-PECTORIS EARLY AFTER ACUTE MYOCARDIAL-INFARCTION (THE GISSI-3 APPI [ANGINA PRECOCE POST-INFARTO] STUDY)

There is conflicting evidence whether or not early postinfarction angi na implies an unfavorable prognosis. This prospective study assessed t he significance and natural history of early angina in a broad populat ion of patients conservatively managed after acute myocardial infarcti on (AMI) and enrolled in the third Gruppo Italiano per lo Studio della Sopravvivenza nel Infarto Miocardico (GISSI-3) trial. Out of 2,363 co nsecutive patients (age 63+/-11; first AMI in 86%; thrombolysis in 74% ) admitted in 31 centers lacking on-site revascularization facilities, early angina associated with transient electrocardiographic (ECG) cha nges was documented in 332 (14%). At multivariate analysis, preinfarct ion angina, age greater than or equal to 70 years, female gender, and history of infarct were significant predictors of early angina. Though the in-hospital course was free from major cardiac events in 78% of p atients after the first anginal episode, reinfarction was more common after early angina (7% vs 2% in patients without, RR 3.1, 95% confiden ce interval [CI] 1.9 to 5.6; p <0.001), and death occurred in 7% of pa tients with early angina (vs 5% of patients without, RR 1.4, Cl 0.9 to 2.4, p=NS). No demographic or clinical characteristics identified pat ients who suffered nonfatal reinfarction after angina, and neither the ECG location (infarct zone or remote) nor patterns of ECG changes dur ing angina proved significant predictors of in-hospital reinfarction o r death. Early angina emerged as the sole independent predictor of 6-m onth cumulative reinfarction (12% vs 5% of patients without, RR 2.9, C l 2.0 to 4.4; p <0.0001) and an independent predictor of death (13% vs 7% of patients without early angina, RR 2.3, Cl 1.6 to 3.3; p <0.0001 ). Early postinfarction angina is a powerful prognostic marker. patien ts with early postinfarction angina had an unfavourable in-hospital ou tcome, but the prospective identification of patients at greater risk of major events after angina remains elusive. Although in-hospital sta bilization was achieved by medical treatment in the majority of patien ts with early angina, their increased 6-month risk of reinfarction and death suggests that a more aggressive management is warranted. (C) 19 96 by Excerpta Medica, Inc.