Long-term prognosis of unheralded myocardial infarction vs chronic angina; role of sex and coronary atherosclerosis burden

Clara Carpeggiani, Claudio Michelassi, Patrizia Landi, Antonio L'Abbate, Clara Carpeggiani, Claudio Michelassi, Patrizia Landi, Antonio L'Abbate

Abstract

Background: Angina pectoris (AP) and unheralded myocardial infarction (MI) are considered random clinical equivalents of ischemic heart disease (IHD). Aim of the study was to evaluate the long-term progression of AP as opposed to unheralded MI as alternative first clinical presentations of IHD and the effect of sex on prognosis.

Methods: The study included 2272 consecutive patients, 1419 MI and 1353 AP, hospitalized from 1995 to 2007 at CNR Clinical Physiology Institute, Pisa, Italy and followed up to December 2013, who fulfilled the following criteria: unheralded MI or AP as first manifestation of IHD; age < = 70 years; known coronary anatomy; at least 10-year follow-up. Fatal and non fatal MI, all-cause, and cardiac deaths were the end-points.

Results: Males were predominant in MI (86%) as compared to AP (77%). Females were predominantly affected by AP (61%, MI 39%), and older than men (61 ± 7 vs 59 ± 8 years, p < 0.001). Coronary stenoses were prevalent in MI. During 115 ± 58 months follow-up, 628 deaths (23%) were observed, including 269 cardiac (43%), and 149 cancer deaths (24%). Long-term prognosis was significantly better in AP than MI group. The lowest prevalence of future MI was recorded in female AP (p < 0.001).

Conclusions: MI as first clinical manifestation of IHD implies a more adverse prognosis than AP; future MI is a rare event in AP; sex influences the first presentation of IHD and its course with possible implications for preventive strategy.

Trial registration: ClinicalTrials.gov NCT01506999.

Keywords: Angina pectoris; Coronary atherosclerosis; Myocardial infarction; Prognosis; Sex.

Conflict of interest statement

Ethics approval and consent to participate

The Pisa University-Hospital Ethics Committee approved the study on November 11, 2014 (Study Protocol n. 335/2014). Patients gave their written consent to participate. The study protocol is partly available at http://www.clinicaltrials.gov (NCT01506999).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Distribution of Coronary Artery Disease in Angina and Myocardial Infarction. The number of diseased coronary vessels (main vessels with > 50% lumen reduction) is reported for angina pectoris and myocardial infarction groups. Normal = normal vessels; minor: minor vessels
Fig. 2
Fig. 2
Kaplan Meyer curves for fatal and non-fatal myocardial infarction in angina pectoris (blue line) and myocardial infarction (green line). MI myocardial infarction
Fig. 3
Fig. 3
Kaplan Meyer curves for fatal and non-fatal myocardial infarction in angina pectoris and myocardial infarction stratified by gender. MI = myocardial infarction. Blue line: females in angina group; yellow line: males in angina group; green line: females in myocardial infarction group; purple line: males in myocardial infarction group

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