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Author Notes:

Corresponding Author: Anna Grodzinsky, 4401 Wornall Road, SLNI CV Research #5603, Kansas City, MO 64111, Phone: 913-932-5475, Fax: 816-932-5613

Dr. Spertus reports significant grants from NIH/NHLBI, PCORI, ACCF, Gilead, Lilly, EvaHeart, Amorcyte. Dr. Spertus has consulted for (all modest): United Healthcare, Genentech, Amgen, Janssen, Novartis. He owns the copyright to the Seattle Angina Questionnaire (significant), Kansas City Cardiomyopathy Questionnaire (significant) and Peripheral Artery Questionnaire (modest) and has an equity interest in HealthOutcomesSciences (significant). The other authors have no disclosures or conflicts of interest to report.d Dr. Foody has consulted for (all modest): Novartis, Merck, AstraZeneca, Amgen Inc., Daiichi Sankyo, Sanofi, Janssen, Amarin, Lilly, Aegerion, Pfizer, Boehringer Ingelheim, Regeneron, Genzyme. Dr. Beltrame reports no direct conflicts of interest; potential disclosures include Servier Laboratories (modest). Dr. Maddox is supported with a VA HSR&D career development award. Dr. Mikhail Kosiborod is a consultant for AstraZeneca , Edwards Life Sciences, Gilead Sciences, Roche, Genentech, Regeneron, Eli Lilly, Amgen, Takeda and ZS Pharma. Dr. Kosiborod has received research support from the American Heart Association, Genentech, Gilead Sciences, Glumetrics, Optiscan, Astra Zeneca and Sanofi.

The remaining authors report no disclosures.

Subjects:

Research Funding:

The PREMIER Registry was supported in part by CV Therapeutics, Palo Alto, CA.

Funding support for the TRIUMPH Registry was received from the National Heart, Lung and Blood Institute (P50 HL077113).

Dr. Grodzinsky was supported by a T32 training grant from the National Heart Lung and Blood Institute (T32HL110837).

The funding agencies had no role in data collection, analysis, interpretation or the decision to submit the results.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. Dr. Spertus owns intellectual property rights to the Seattle Angina Questionnaire.

Keywords:

  • Acute myocardial infarction
  • Angina
  • Coronary artery disease

Angina Frequency After Acute Myocardial Infarction In Patients Without Obstructive Coronary Artery Disease.

Tools:

Journal Title:

European Heart Journal

Volume:

Volume 1, Number 2

Publisher:

, Pages 92-99

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Background Myocardial infarction (MI) patients without obstructive coronary artery disease (CAD) are at increased risk for recurrent ischemic 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 (SAQ). A hierarchical repeated measures modified Poisson model assessed the association between the absence of obstructive CAD (defined as epicardial stenoses >70% or left main >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 NSTEMI (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 (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 PHQ, 95% CI 1.17-1.41; IRR=1.34, 95% 1.02-1.1.74). Conclusions 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 anti-anginal strategies are needed to improve their health status and quality of life.

Copyright information:

© 2015, Oxford University Press

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