engleski

Effects of preceding angina pectoris on short-term outcome of patients with acute myocardial infarction

Several studies reporting on the significance and prognostic importance of antecedent angina pectoris (AP) in patients with acute myocardial infarction (AMI) gave opposing results. The aim of this study was to evaluate the influence of a history of AP on short term outcome of patients with AMI. A total of 1370 consecutive patients admitted for AMI were studied and divided in two groups. Four hundred seventy– two patients (49%) had chronic AP (>1 month) before AMI, and 698 patients had no history of AP. Patients with AP were older (mean age 63± ; 11 vs 61± ; 11 years, p<0.01), had a higher incidence of hypertension (60% vs 51%, p<0.001), previous myocardial infarction (37% vs 5% p<0.001), were less likely to be smokers (29% vs 48%, p<0.001), more often had signs of left ventricular dysfunction (Killip class > 1) on admission (33% vs 22%, p<0.001), and presented more frequently with non– Q AMI (12% vs 7%, p=0.002). Their in-hospital course was characterized by higher incidence of severe ventricular dysfunction (Killip class 3 and 4, 14% vs 7%, p<0.001), and higher overall mortality rate (13% vs 8%, p=0.003). Cardiogenic shock was the cause of death in 66% percent of patients with AP and in 42% patients without AP who succumbed to AMI (p=0.005). Furthermore shock was more often fatal complication in patients with AP than in those without AP (fatality rate of 94% vs 76%, respectively, p=0.012). The incidence of reccurent ischemia was also higher in patients with preceding AP (24% vs 11%, p<0.001). There were no significant differences between two groups of patients regarding gender, incidence of diabetes mellitus, hyperlipoproteinemia, occurrence of rhythm disturbance, (atrial fibrillation, ventricular tachycardia, ventricular fibrillation, AV conduction disturbances), thrombolytic treatment and enzymatic indices of infarct size. However, a multivariate analysis, taking into account all variables that were significant in univariate analysis, confirmed the independent association of antecedent AP only with age (p=0.009), history of smoking (p=0.021), previous myocardial infarction (p=0.005), incidence of non- Q AMI (p=0.035) and recurrent ischemia (p<0.001). It is concluded that cronic AP preceding AMI predicts recurrent ischemia and the development of non-Q AMI, but that is not independently associated with the occurrence of in-hospital complications or mortality.

Myocardial infarction; prognosis

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