PROGNOSTIC VALUE OF CLINICAL-VARIABLES FOR RECURRENT ISCHEMIC EVENTS AFTER ACUTE MYOCARDIAL-INFARCTION

Recurrent ischemia after acute myocardial infarction (AMI) has been la rgely associated with a poor prognosis. This study was carried out to analyze the relationship among different clinical variables and both p ostinfarction angina and reinfarction after AMI. A total of 452 consec utive patients (mean age 58.2 +/- 12 years) were admitted to the coron ary care unit and were studied prospectively. More than half of the pa tients received some type of thrombolytic therapy. Death occurred in 4 5 patients (9.9%) during hospital stay. Postinfarction angina was diag nosed in 81 patients (17.9%) and reinfarction in 22 (4.9%). Patients w ho developed reinfarction had a high mortality rate (45.5%) compared w ith those who did not develop such an event (8.1%) (p < 0.0001; odds r atio: 9.4; 95% confidence interval 3.5-25.4). On the other hand, posti nfarction angina had no significant association with mortality. Multiv ariate analysis revealed that a history of angina (> 1 week) was predi ctive of the occurrence of postinfarction angina and that the use of f ibrinolytic treatment, prodromal symptoms, and postinfarction angina w ere significantly related to reinfarction. We conclude that several si mple clinical variables are clear independent predictors of postinfarc tion angina and reinfarction following AMI and should be taken into ac count in routine clinical practice or when planning intervention trial s.