Course of angina pectoris after an acute coronary event
Insights
Postcoronary angina pectoris frequently develops after myocardial infarction or unstable angina. Angina presence impacts long-term survival, highlighting the need for effective treatment strategies.
Area of Science:
- Cardiology
- Clinical Medicine
- Epidemiology
Background:
- Postcoronary angina pectoris (PCAP) management and prognosis remain areas of significant clinical interest.
- Understanding the long-term course of PCAP in medically treated patients is crucial for evaluating treatment efficacy.
Purpose of the Study:
- To examine the long-term course and prognostic implications of postcoronary angina pectoris in male survivors of myocardial infarction or unstable angina.
- To assess the relationship between the presence of angina and long-term survival in this patient cohort.
Main Methods:
- A prospective follow-up study involving 555 men aged under 60, survivors of a first myocardial infarction or unstable angina.
- Yearly follow-up for up to 17 years, with data collection on anginal symptoms, treatment, and survival.
- Analysis of the incidence and duration of angina, and its association with mortality.
Main Results:
- One year post-infarction, 24.1% reported angina; this proportion rose to 43.5% by 15 years.
- 35.3% of survivors never reported anginal symptoms up to 17 years post-event.
- Patients experiencing angina within the first year had poorer long-term survival and longer periods with angina, although it resolved in 41.7% before death.
Conclusions:
- The presence and absence of angina can fluctuate significantly over time in medically treated patients post-coronary event.
- Angina is associated with a poorer long-term prognosis, underscoring its clinical significance.
- Findings have implications for assessing the impact of treatments like coronary artery bypass surgery on postcoronary angina.
Abstract:
The course of postcoronary angina pectoris was examined in 555 men who had survived a first attack of myocardial infarction or unstable angina. Patients were aged less than 60 and were followed up yearly for up to 17 years. Only 25 (4.5%) had coronary artery bypass surgery. Most patients with angina were treated by nitrates alone. One year after infarction 24.1% of survivors (124/515) reported the presence of angina pectoris, and the proportions at five, 10, and 15 years were 29.9%, 30.4%, and 43.5% respectively. Seventeen years after the initial event 35.3% of the survivors had never reported postcoronary anginal symptoms. The patients who experienced anginal symptoms in the year after their coronary attack had a poorer long term survival than the group who were symptom free over the first year. These patients also had longer subsequent periods with angina, though in 41.7% angina resolved before death after a median of 2.9 years. Throughout follow up mortality during periods in which patients experienced angina was higher than in the symptom free periods. This long term follow up study of patients after a coronary event confirms that the presence or absence of angina may vary considerably over time in patients treated medically and that the presence of angina is associated with a poorer prognosis. These findings have important implications when assessing the effects of various treatment modalities on postcoronary angina, including coronary artery bypass surgery.
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