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Preinfarction angina as a major predictor of left ventricular function and long-term prognosis after a first Q wave

T Anzai1, T Yoshikawa, Y Asakura

  • 1Department of Medicine, Keio University School of Medicine, Tokyo, Japan.

Journal of the American College of Cardiology
|August 1, 1995
PubMed

Insights

Preinfarction angina, or chest pain before a heart attack, appears to improve outcomes. This includes reduced mortality and better heart function, particularly after anterior myocardial infarction.

Area of Science:

  • Cardiology
  • Cardiovascular Research
  • Myocardial Infarction Research

Background:

  • The prognostic impact of preinfarction angina following myocardial infarction (MI) is not fully understood.
  • Previous research has not clearly differentiated the effects of preinfarction angina in anterior versus inferior MI.
  • Understanding these effects is crucial for optimizing patient management and predicting outcomes after MI.

Purpose of the Study:

  • To evaluate the prognostic significance of preinfarction angina in patients experiencing their first Q wave myocardial infarction.
  • To compare the outcomes of patients with anterior MI versus inferior MI in relation to preinfarction angina.
  • To investigate the association between preinfarction angina and left ventricular function assessed by ventriculography.

Main Methods:

  • A cohort of 291 patients with a first Q wave anterior (n=171) or inferior (n=120) MI was analyzed.
  • The study assessed the impact of preinfarction angina on short- and long-term prognosis.
  • Predischarge left ventriculographic findings were examined in relation to the presence of preinfarction angina.

Main Results:

  • Preinfarction angina was linked to lower peak creatine kinase, reduced in-hospital ventricular arrhythmias, and decreased pump failure and mortality in both anterior and inferior MI.
  • In anterior MI patients, preinfarction angina correlated with lower cardiac rupture incidence, less heart failure readmission within one year, improved ejection fraction, smaller end-diastolic volume, and reduced aneurysm formation.
  • Multivariate analysis identified preinfarction angina as an independent predictor for ventricular aneurysm, late heart failure, and 1-year cardiac mortality.

Conclusions:

  • Preinfarction angina demonstrates a favorable effect on infarct expansion and late left ventricular function, especially in anterior MI.
  • Potential mechanisms, possibly involving infarct size limitation through pathways like ischemic preconditioning, warrant further investigation.
  • These findings suggest preinfarction angina may confer a protective effect, influencing myocardial remodeling and long-term outcomes.
Abstract

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