Myocardial infarction: early post-infarction angina was common and increased the risk of dying.

Clinical bottom line (level 1b)

  1. One in nine patients with a myocardial infarction developed angina severe enough to require medication in hospital.
  2. 4% were dead within a year, and 3% had another myocardial infarction.
  3. Early postinfarction angina increased the risk of dying from heart disease.
Galjee et al: American Heart Journal 1992; 125 (1): 48-55
Expires March 2003

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, the Netherlands

231 patients (aged mean 53, 88% male) first acute myocardial infarction (diagnosed by a typical history with ECG and enzymatic changes) who developed early postinfarction angina (angina at rest or after minimal exercise during hospitalisation 24 hours or more after admission requiring drug treatment)

Excluded if
  • significant valvular heart disease
  • major coexisting non-cardiac disease that might affect normal life expectancy
  • transferred from another hospital
  • aged > 65



Factors studied:
  • previous angina, ejection fraction, angiographic findings, ECG findings




Multivariate regression analysis performed to adjust for confounding factors.

100% followed for 12 months
Outcomes studied:
  • early post-infarction angina angina occurring at rest or on minimal exertion during hospitalisation 24 hours or more after admission requiring drug therapy
  • death
  • recurrent infarction

The evidence

outcome time to outcome number of patients/total number %
(95% CI)		 NNF
(95% CI)
early post-infarction angina 12 months 27/231 12%
(7.5% to 16%)		 9
(6 to 13)
death 12 months 9/231 3.9%
(1.4% to 6.4%)		 26
(16 to 71)
recurrent infarction 12 months 6/231 2.6%
(0.54% to 4.7%)		 39
(22 to 180)

  • The risk of dying from heart disease was increased with
    • early postinfarction angina
    • reduced left ventricular end-diastolic pressure
    • reduced ejection fraction
    • angina before MI
  • The risk of a recurrent myocardial infarction was increased with
    • angiographic findings
    • ST-segment depression on exercise test
    • angina before MI

Comments

  1. There was no significant difference in the rate of revascularisation between the two groups.

Citation

  1. Galjee MA, Visser FC, De Cock CC, et al: The prognostic value, clinical and angiographic characteristics of patients with early postinfarction angina after a first myocardial infarction. American Heart Journal 1992; 125 (1): 48-55
Search Terms: infarct* in Cochrane
Contributor: Chris Ball and Clare Wotton, February 2000
Reviewer:

Clinical Question.
    Patient acute myocardial infarction
    Intervention or Exposure early post-infarction angina
    Outcome death or recurrent myocardial infarction