Does angina the week before protect against first myocardial infarction inelderly patients?

Mortality rates for coronary artery disease are greater in elderly patients . Although prodromal angina occurring shortly before an acute myocardial in farction (MI) has protective effects against ischemia, this effect has not been well documented in older patients. This study investigated whether ang ina 1 week before a first MI provides protection in this group of patients. A total of 290 consecutive elderly (>64 years old, n = 143) and adult pati ents (<65 years old, n = 147) with a first MI were examined to assess the e ffect of preceding angina on the short- and long-term prognosis. Elderly pa tients with a history of prodromal angina were less likely than those witho ut angina to experience in-hospital death, heart failure, or the combined e nd point of in-hospital death and heart failure (6% vs 20.4%, p = 0.02; 10% vs 23.7%, p = 0.07; 14% vs 32.3%, p = 0.01, respectively). Left ventricula r function was more frequently depressed (ejection fraction <40%) in elderl y patients without (44.8%) than with (26%, p = 0.04) preinfarction angina, and the incidence of arrhythmias (complete heart block and ventricular fibr illation) was greater in the former group (16.1% vs 4%, p = 0.03). Multivar iate analysis confirmed that the presence of preinfarction angina was an in dependent predictor of in-hospital death and heart failure in older patient s (odds ratio 0.28, p = 0.009). The occurrence of angina 1 week before ct f irst MI may confer protection against in-hospital adverse outcomes, and may preserve left ventricular function in older patients. (C) 2001 by Excerpta Medica, Inc.