Importance of early recurrent ischemia on one-year survival after non-Q-wave acute myocardial infarction

William E. Boden, Robert S. Gibson, Robert E. Kleiger, Kenneth B. Schechtman, Robert J. Capone, David J. Schwartz, Robert Roberts

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8 Scopus citations

Abstract

Several studies have emphasized the prognostic importance of early postinfarction myocardial ischemia-defined as angina with transient ST-T wave changes ≥24 hours after an acute myocardial infarction (AMI)-on short-term outcome in patients with non-Q-wave AMI.1-5 Risk stratification after AMI is generally based on the early clinical features associated with infarction and on the delineation of high-risk predischarge variables.5,6 Thus, the importance of clarifying the prognostic significance of early postinfarction angina on late outcome after non-Q-wave AMI is apparent. Previously, we reported that spontaneous postinfarction angina associated with ischemic ST-T wave changes was an especially severe form of early recurrent ischemia that frequently presaged infarct extension and death within 14 days of non-Q-wave AMI.7 Overall, patients with early recurrent ischemia exhibited a 4-fold increased incidence of MB-creatine kinase-confirmed reinfarction, and a 10-fold increased incidence of death within 2 weeks, compared to patients without it.7 In the present study, we used the extensive database created for the Diltiazem Reinfarction Study for 2 purposes. The first was to determine if post-AMI angina complicating non-Q-wave AMI before hospital discharge was associated with a worse late prognosis (i.e., higher reinfarction and mortality at 1 year) in those patients surviving until hospital discharge. The second was to assess whether spontaneous angina associated with transient ischemic electrocardiographic changes during the early recovery phase of non-Q-wave AMI was as predictive of adverse long-term outcome as it was of poor short-term outcome during hospitalization.

Original languageEnglish
Pages (from-to)799-801
Number of pages3
JournalThe American journal of cardiology
Volume64
Issue number12
DOIs
StatePublished - Oct 1 1989
Externally publishedYes

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