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

• Authors: Anna Grodzinsky, University of Missouri-Kansas City; Suzanne V. Arnold, University of Missouri-Kansas City; Kensey Gosch, University of Missouri-Kansas City; John A. Spertus, University of Missouri-Kansas City; Joanne M. Foody, Brigham and Women’s Hospital; John Beltrame, University of Adelaide; Thomas M. Maddox, VA Eastern Colorado Health Care System; Susmita Parashar, Emory University; Mikhail Kosiborod, University of Missouri-Kansas City
• Journal Title: European Heart Journal
• Volume: Volume 1, Number 2
• Publisher: Oxford University Press (OUP): Policy B - Oxford Open Option B - CC-BY | 2015-07-23, Pages 92-99
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1093/ehjqcco/qcv014
• Subjects: Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management
• Keywords: Acute myocardial infarction; Angina; Coronary artery disease

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.