THE PROGNOSTIC VALUE, CLINICAL, AND ANGIOGRAPHIC CHARACTERISTICS OF PATIENTS WITH EARLY POSTINFARCTION ANGINA AFTER A 1ST MYOCARDIAL-INFARCTION

To evaluate the prognostic value of early postinfarction angina and its relationship to clinical and angiographic variables, 231 consecutive patients who had had a first myocardial infarction were studied. All underwent cardiac catheterization within 10 weeks after admission to the hospital. There were no differences in basic characteristics or in ejection fraction, extent or severity of coronary artery disease, or collateral circulation between the patients with early postinfarction angina (n = 27) and those without early postinfarction angina (n = 204) except for the incidence of angina before myocardial infarction. Patients with early postinfarction angina had exercise-induced angina (42% vs 21 %; p < 0.025) more frequently and shorter exercise duration (6.9 +/- 2.5 minutes vs 8.3 +/- 2.5 minutes; p = 0.007). Early postinfarction angina was associated with a significantly higher event rate (15% vs 4%; p < 0.025) and a significantly higher mortality rate (15% vs 3%; p < 0.005) in the first year after infarction but not during the subsequent 4-year follow-up. In patients with early postinfarction angina, stress test results had no predictive value for future cardiac events in contrast to patients without early postinfarction angina in whom ST-segment depression as observed on the stress test ECG and exercise duration had predictive value for future cardiac events. In patients with early postinfarction angina there was no relationship between the incidence of events and the number of diseased vessels in contrast to patients without early postinfarction angina who had a high incidence of events when three-vessel disease was present (16% vs 62%; p < 0.0001). Logistic regression analysis demonstrated that early postinfarction angina was the strongest predictor of cardiac death in the first year after a first myocardial infarction. In summary, early postinfarction angina has no relationship to the extent or severity of vessel disease and is an independent prognostic variable in patients who have had a first myocardial infarction.