TY - JOUR
T1 - Angina frequency after acute myocardial infarction in patients without obstructive coronary artery disease
AU - Grodzinsky, Anna
AU - Arnold, Suzanne V.
AU - Gosch, Kensey
AU - Spertus, John A.
AU - Foody, Joanne M.
AU - Beltrame, John
AU - Maddox, Thomas M.
AU - Parashar, Susmita
AU - Kosiborod, Mikhail
N1 - Publisher Copyright:
© The Author 2015.
PY - 2015/11
Y1 - 2015/11
N2 - Aims Myocardial infarction (MI) patients without obstructive coronary artery disease (CAD) are at increased risk for recurrent ischaemic events, but angina frequency post-MI has not been described. Methods and results Among MI patients who underwent angiography, we assessed angina at baseline, 1, 6, and 12 months using the Seattle Angina Questionnaire. A hierarchical repeated-measures-modified Poisson model assessed the association between the absence of obstructive CAD (defined as epicardial stenosis .70% or left main stenosis .50%) and angina. Among 5539 MI patients from 31 US hospitals (mean age 60, 68% male), 6.9% had no angiographic obstructive CAD. More patients without obstructive CAD (vs. obstructive CAD) were female (57 vs. 30%), non-white (51 vs. 24%), and had non ST elevation myocardial infarction (87 vs. 51%). In unadjusted analyses, patients without obstructive CAD had less angina prior to MI, but more angina and worse health status post-discharge. After adjustment for socio-demographic and clinical factors, the risk of post-MI angina was similar in patients without vs. with obstructive CAD [incidence rate ratio (IRR) = 0.89, 95% CI 0.77-1.02]. Among patients without obstructive CAD, depression and self-reported avoidance of care due to cost were independently associated with angina (IRR = 1.28 per 5 points on Patient Health Questionnaire, 95% CI 1.17-1.41; IRR = 1.34, 95% CI 1.02-1.1.74). Conclusion Following MI, patients without obstructive CAD experience an angina burden at least as high as those with obstructive CAD, affecting 1 in 4 patients at 12 months. As these patients are not candidates for revascularization, other antianginal strategies are needed to improve their health status and quality of life.
AB - Aims Myocardial infarction (MI) patients without obstructive coronary artery disease (CAD) are at increased risk for recurrent ischaemic events, but angina frequency post-MI has not been described. Methods and results Among MI patients who underwent angiography, we assessed angina at baseline, 1, 6, and 12 months using the Seattle Angina Questionnaire. A hierarchical repeated-measures-modified Poisson model assessed the association between the absence of obstructive CAD (defined as epicardial stenosis .70% or left main stenosis .50%) and angina. Among 5539 MI patients from 31 US hospitals (mean age 60, 68% male), 6.9% had no angiographic obstructive CAD. More patients without obstructive CAD (vs. obstructive CAD) were female (57 vs. 30%), non-white (51 vs. 24%), and had non ST elevation myocardial infarction (87 vs. 51%). In unadjusted analyses, patients without obstructive CAD had less angina prior to MI, but more angina and worse health status post-discharge. After adjustment for socio-demographic and clinical factors, the risk of post-MI angina was similar in patients without vs. with obstructive CAD [incidence rate ratio (IRR) = 0.89, 95% CI 0.77-1.02]. Among patients without obstructive CAD, depression and self-reported avoidance of care due to cost were independently associated with angina (IRR = 1.28 per 5 points on Patient Health Questionnaire, 95% CI 1.17-1.41; IRR = 1.34, 95% CI 1.02-1.1.74). Conclusion Following MI, patients without obstructive CAD experience an angina burden at least as high as those with obstructive CAD, affecting 1 in 4 patients at 12 months. As these patients are not candidates for revascularization, other antianginal strategies are needed to improve their health status and quality of life.
KW - Acute myocardial infarction
KW - Angina
KW - Coronary artery disease
UR - http://www.scopus.com/inward/record.url?scp=85017497766&partnerID=8YFLogxK
U2 - 10.1093/ehjqcco/qcv014
DO - 10.1093/ehjqcco/qcv014
M3 - Article
C2 - 28239487
AN - SCOPUS:85017497766
VL - 1
SP - 92
EP - 99
JO - European Heart Journal - Quality of Care and Clinical Outcomes
JF - European Heart Journal - Quality of Care and Clinical Outcomes
SN - 2058-5225
IS - 2
ER -