ABSTRACT
BACKGROUND AND HYPOTHESIS: Although prodromal angina occurring shortly before an acute myocardial infarction (MI) has protective effects against in-hospital complications, this effect has not been well documented after initial hospitalization, especially in older or diabetic patients. We examined whether angina 1 week before a first MI provides protection in these patients. METHODS: A total of 290 consecutive patients, 143 elderly (>64 years of age) and 147 adults (<65 years of age), 68 of whom were diabetic (23.4%) and 222 nondiabetic (76.6%), were examined to assess the effect of preceding angina on long-term prognosis (56 months) after initial hospitalization for a first MI. RESULTS: No significant differences were found in long-term complications after initial hospitalization in these adult and elderly patients according to whether or not they had prodromal angina (44.4% with angina vs 45.4% without in adults; 45.5% vs 58% in elderly, P < 0.2). Nor were differences found according to their diabetic status (61.5% with angina vs 72.7% without in diabetics; 37.3% vs 38.3% in nondiabetics; P = 0.4). CONCLUSION: The occurrence of angina 1 week before a first MI does not confer long-term protection against cardiovascular complications after initial hospitalization in adult or elderly patients, whether or not they have diabetes.
Subject(s)
Angina Pectoris/complications , Diabetes Complications , Myocardial Infarction/complications , Thrombolytic Therapy , Aged , Angina Pectoris/mortality , Angina Pectoris/therapy , Angina, Unstable/etiology , Diabetes Complications/mortality , Diabetes Complications/therapy , Heart Failure/etiology , Hospitalization , Humans , Middle Aged , Myocardial Infarction/mortality , Myocardial Infarction/therapy , Patient Readmission , Proportional Hazards Models , Recurrence , Retrospective Studies , Risk Assessment , Risk Factors , Thrombolytic Therapy/adverse effects , Thrombolytic Therapy/mortality , Time Factors , Treatment OutcomeABSTRACT
The occurrence of angina in the week preceding myocardial infarction is associated with a reduction in cardiovascular complications in the acute phase. However, little is known about it relationship with prognosis after hospitalization (e.g., cardiovascular death and the development of heart failure or ischemic cardiomyopathy). The study included 290 consecutive patients admitted for a first myocardial infarction: 107 (36.9%) had preceding angina while 183 did not. Those with a history of ischemic cardiomyopathy of more than 1 week or structural cardiopathy were excluded. There was no difference in baseline characteristics between the two groups. Moreover, there was no difference in the rates of cardiovascular complications after hospital discharge: cardiovascular death (7% vs. 12.6%; P=.3), heart failure (7.4% vs. 11.6%; P=.2), and myocardial ischemia, including myocardial infarction and unstable angina, requiring hospitalization (41.2% vs. 31.3%; P=.3). The occurrence of angina in the week before a first myocardial infarction did not influence cardiovascular complications after hospital discharge (odds ratio = 0.75 [0.51-1.11]; P=.15).
Subject(s)
Angina Pectoris/complications , Cardiovascular Diseases/complications , Myocardial Infarction/complications , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/mortality , Female , Humans , Male , Middle Aged , Patient Discharge , Prognosis , Retrospective Studies , Time FactorsABSTRACT
La angina preinfarto precoz (semana previa) se asociaa una reducción de las complicaciones cardiovascularesen la fase aguda del infarto, pero es escasa la información sobre su relación con el pronóstico tras la fase hospitalaria (muerte cardiovascular y desarrollo de insuficiencia cardiaca e isquemia miocárdica). Estudiamos a 290 pacientes consecutivos ingresados con un primer infarto, 107 con angina precoz (36,9%) y 183 sin ella. Se excluyó a los pacientes con antecedentes de cardiopatía isquémica de más de 1 semana o cardiopatía estructural de base. No se aprecian diferencias en las características basales de ambos grupos. No hay diferencias en las complicaciones cardiovasculares tras el alta hospitalaria (mortalidad cardiovascular, 7 frente a 12,6%; p = 0,3), insuficienciacardiaca (7,4 frente a 11,6%; p = 0,2) o isquemiamiocárdica (infarto o angina inestable, 41,2 frente a31,3%; p = 0,3) que motiven ingreso hospitalario. La angina precoz no es un factor asociado a complicaciones cardiovasculares tras el alta hospitalaria (odds ratio = 0,75; intervalo de confianza del 95%, 0,51-1,11; p = 0,15)
The occurrence of angina in the week precedingmyocardial infarction is associated with a reduction incardiovascular complications in the acute phase.However, little is known about it relationship withprognosis after hospitalization (e.g., cardiovascular death and the development of heart failure or ischemiccardiomyopathy). The study included 290 consecutivepatients admitted for a first myocardial infarction: 107(36.9%) had preceding angina while 183 did not. Thosewith a history of ischemic cardiomyopathy of more than 1week or structural cardiopathy were excluded. There wasno difference in baseline characteristics between the twogroups. Moreover, there was no difference in the rates ofcardiovascular complications after hospital discharge:cardiovascular death (7% vs. 12.6%; P=.3), heart failure(7.4% vs. 11.6%; P=.2), and myocardial ischemia,including myocardial infarction and unstable angina,requiring hospitalization (41.2% vs. 31.3%; P=.3). Theoccurrence of angina in the week before a first myocardial infarction did not influence cardiovascular complications after hospital discharge (odds ratio = 0.75 [0.511.11]; P=.15) (AU)
Subject(s)
Humans , Myocardial Infarction/complications , Angina, Unstable/epidemiology , Myocardial Infarction/physiopathology , PrognosisABSTRACT
Introducción y objetivos. Existe controversia sobre el efecto de la angina de reciente comienzo en el pronóstico de los pacientes que presentan un infarto agudo de miocardio. El objetivo de este estudio fue determinar si esta angina confiere protección respecto a las complicaciones intrahospitalarias y en el seguimiento a medio plazo en pacientes con un primer infarto agudo de miocardio. Pacientes y método. Estudiamos a un total de 290 pacientes consecutivos ingresados con un primer infarto, 107 con angina de reciente comienzo en la semana previa y 183 sin ella, excluyendo a aquellos con antecedentes de cardiopatía isquémica de más de una semana de evolución o cardiopatía estructural de base. Estudiamos su pronóstico intrahospitalario y en el seguimiento a medio plazo (muerte e insuficiencia cardíaca). Resultados. Los pacientes con angina de reciente comienzo previo al infarto presentaron un menor número de muertes (3,7 frente a 11,5 por ciento), insuficiencia cardíaca (4,6 frente a 15,8 por ciento) y su combinación (7,5 frente a 21,3 por ciento) (p = 0,002). Esta asociación se confirma en el seguimiento (4,1 frente a 13,2 por ciento; p = 0,03). En el análisis multivariado, la angina de reciente comienzo preinfarto constituía un factor predictor de presentar un menor número de muertes y de desarrollar insuficiencia cardíaca en la fase hospitalaria y en el seguimiento. Conclusiones. La presencia de angina de reciente comienzo previa al primer infarto agudo de miocardio se asocia a una disminución del número de pacientes que mueren o presentan insuficiencia cardíaca, tanto en la fase hospitalaria como en el seguimiento a medio plazo (AU)
