Highlights
- •The prevalence of preinfarction AP was 19.4% in patients with STEMI who underwent PCI.
- •Preinfarction AP was associated with limited infarct size.
- •Preinfarction AP was independently associated with a lower 5-year mortality.
- •Mortality in patients with preinfarction AP was less affected by total ischemic time.
The influence of preinfarction angina pectoris (AP) on long-term clinical outcomes
in patients with ST-segment elevation myocardial infarction (STEMI) who underwent
primary percutaneous coronary intervention (PCI) remains controversial. In 5,429 patients
with acute myocardial infarction (AMI) enrolled in the Coronary Revascularization
Demonstrating Outcome Study in Kyoto AMI Registry, the present study population consisted
of 3,476 patients with STEMI who underwent primary PCI within 24 hours of symptom
onset and in whom the data on preinfarction AP were available. Preinfarction AP defined
as AP occurring within 48 hours of hospital arrival was present in 675 patients (19.4%).
Patients with preinfarction AP was younger and more often had anterior AMI and longer
total ischemic time, whereas they less often had history of heart failure, atrial
fibrillation, and shock presentation. The infarct size estimated by peak creatinine
phosphokinase was significantly smaller in patients with than in patients without
preinfarction AP (median [interquartile range] 2,141 [965 to 3,867] IU/L vs 2,462
[1,257 to 4,495] IU/L, p <0.001). The cumulative 5-year incidence of death was significantly
lower in patients with preinfarction AP (12.4% vs 20.7%, p <0.001) with median follow-up
interval of 1,845 days. After adjusting for confounders, preinfarction AP was independently
associated with a lower risk for death (hazard ratio 0.69, 95% confidence interval
0.54 to 0.86, p = 0.001). The lower risk for 5-year mortality in patients with preinfarction
AP was consistently observed across subgroups stratified by total ischemic time, initial
Thrombolysis In Myocardial Infarction flow grade, hemodynamic status, infarct location,
and diabetes mellitus. In conclusion, preinfarction AP was independently associated
with lower 5-year mortality in patients with STEMI who underwent primary PCI.
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Article info
Publication history
Published online: July 29, 2014
Accepted:
July 9,
2014
Received in revised form:
July 9,
2014
Received:
May 22,
2014
Footnotes
This study was supported by the Ministry of Health, Labour and Welfare and the Pharmaceuticals and Medical Devices Agency in Japan.
See page 1185 for disclosure information.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
