[en] To determine if the occurrence and the consequences of spontaneous predischarge postinfarction ischemia could be predicted early after hospital admission, a consecutive series of patients with acute myocardial infarction was studied and followed for 3 years. No patient was treated by thrombolysis. Spontaneous predischarge ischemia was defined as angina that occurred at rest before hospital discharge, at least 3 days after the acute event, and that was accompanied by electrocardiographic changes, but not by an increase in cardiac enzymes. Patients who died within the first 3 days were excluded from analysis. Among the 943 patients who survived at least 3 days, 165 (17.5%) had spontaneous ischemia before discharge. They had a higher 1-year post-hospital mortality (16 vs. 10%), but did not have significantly higher total 3-year mortality rates. Four independent, early available variables predictive of the occurrence of spontaneous ischemia were selected from a stepwise logistic discriminant analysis: history of angina before infarction, non-Q-wave infarct, absence of smoking, and higher age. Among the 165 patients with spontaneous ischemia, 3 independent variables predictive of 3-year mortality were selected stepwise: left ventricular function score, history of previous infarction, and absence of smoking.
Disciplines :
General & internal medicine
Author, co-author :
PIERARD, Luc ; Centre Hospitalier Universitaire de Liège - CHU > Cardiologie
Albert, Adelin ; Université de Liège - ULiège > Département des sciences de la santé publique > Informatique médicale et biostatistique
Kulbertus, H. E.
Language :
English
Title :
Predictors of Spontaneous Predischarge Ischemia Following Acute Myocardial Infarction
Publication date :
April 1992
Journal title :
Clinical Cardiology: International Journal for Cardiovascular Diseases
ISSN :
0160-9289
eISSN :
1932-8737
Publisher :
Wiley-Blackwell, Hoboken, United States - New Jersey
Schuster EH, Bulkey BH (1980) Ischemia at a distance after acute myocardial infarction: A cause of early postinfarction angina. Circulation 62:509-515.
Schuster EH, Bulkley BH (1981) Early post‐infarction angina. Ischemia at a distance and ischemia in the infarct zone. N Engl J Med 305:1101-1105.
Albert A, Anderson JA (1981) Probit and logistic discriminant functions. Commun Stat 10 A:641-647.
Marmor A, Geltman EM, Schechtman K, Sobel BE, Roberts R (1982) Recurrent myocardial infarction: Clinical predictors and prognostic implications. Circulation 66:415-421.
Figueras J, Cinca J, Valla V, Rius J (1983) Prognostic implications of early spontaneous angina after acute transmural myocardial infarction. Int J Cardiol 4:261-272.
Fioretti P, Brower RW, Balakumaran K (1986) Early post‐infarction angina. Incidence and prognostic relevance. Eur Heart J 7:73-77.
Benhorin J, Andrews ML, Carleen ED (1988) Occurrence, characteristics and prognostic significance of early postacute myocardial infarction angina pectoris. Am J Cardiol 62:679-685.
Bosch X, Theroux P, Waters DD, Pelletier BG, Roy D (1987) Early post‐infarction ischemia: Clinical, angiographic, and prognostic significance. Circulation 75:988-995.
Campolo L, De Biase AM, Mafrici A, Cataldo G, Merlini PA, Pirellis S, Mauri F, Rovelli F (1986) Indications for surgical treatment in post‐infarction angina. Eur Heart J 7:103-109.
Fujita M, Sasayama S, Ohno A, Nakajima H, Asanoi H (1987) Importance of angina for development of collateral circulation. Br Heart J 57:139-143.
Cortina A, Ambrose JA, Prieto‐Granda J, Morris C, Simarro E, Holt J, Fuster V (1985) Left ventricular function after myocardial infarction: Clinical and angiographic correlations. J Am Coll Cardiol 5:619-624.
Midwall J, Ambrose J, Pichard A, Abedin Z, Herman MV (1982) Angina pectoris before and after myocardial infarction. Angiographic correlations. Chest 81:681-686.
Bergelson BA, Ruocco NA, Ryan TJ, Hankin BR, Jacobs AK, Faxon DP (1989) Antecedent angina: A predictor of residual stenosis after thrombolytic therapy. J Am Coll Cardiol 14:91-95.
Dwyer EM, Greenberg H, Case RB (1986) and the Multicenter Postinfarction Research Group: Association between transient pulmonary congestion during acute myocardial infarction and high incidence of death in six months. Am J Cardiol 58:900-905.
Piérard LA, Dubois C, Smeets JP, Boland J, Carlier J, Kulbertus HE (1988) Prognostic significance of angina pectoris before first acute myocardial infarction. The American Journal of Cardiology 61:984-987.
Gibson RS, Beller GA, Gheorghiade M, Nygaard TW, Watson DD, Huey BL, Sayre SL, Kaiser DL (1986) The prevalence and clinical significance of residual myocardial ischemia 2 weeks after uncomplicated non‐Q wave infarction: A prospective natural history study. Circulation 73:1186-1198.
DeWood MA, Stifter WF, Simpson CS, Spores J, Eugster GS, Judge TP, Hinnen ML (1986) Coronary arteriographic findings soon after non‐Q wave myocardial infarction. N Engl J Med 315:417-423.
Wilhelmsson C, Vedin JA, Elmfeldt D, Tibblin G, Wilhelmsen L (1975) Smoking and myocardial infarction. Lancet 1:415-420.
Fitzgerald GA, Oates JA, Nowak J (1988) Cigarette smoking and hemostatic function. Am Heart J 115:267-271.
Kelly TL, Gilpin E, Ahnve S, Henning H, Ross J (1985) Smoking status at the time of acute myocardial infarction and subsequent prognosis. Am Heart J 110:535-541.
Molstad P (1991) First myocardial infarction in smokers. Eur Heart J 12:753-759.
Krainin FM, Flessas AP, Spodick DH (1984) Infarction‐associated pericarditis. Rarity of diagnostic electrocardiograms. N Engl J Med 311:1211-1214.
Ellis SG, Topol EJ, George BS, Keriakes DJ, Debowey D, Sigmon KN, Pickel A, Lee KL, Califf RM (1989) Recurrent ischemia with warning. Analysis of risk factors for in‐hospital ischemic events following successful thrombolysis with intravenous tissue plasminogen activator. Circulation 80:1159-1165.
Ellis SG, Debowey D, Bates ER, Topol EJ (1991) Treatment of recurrent ischemia after thrombolysis and successful reperfusion for acute myocardial infarction: Effect on in‐hospital mortality and left ventricular function. J Am Coll Cardiol 17:752-757.
Braunwald E (1990) Optimizing thrombolytic therapy of acute myocardial infarction. Circulation 82:1510-1513.