Format

Send to

Choose Destination
Int J Cardiol. 2015;187:462-9. doi: 10.1016/j.ijcard.2015.03.328. Epub 2015 Mar 21.

Time-dependent effect of preinfarction angina pectoris and intermittent claudication on mortality following myocardial infarction: A Danish nationwide cohort study.

Author information

1
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark; Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark. Electronic address: morten.schmidt@clin.au.dk.
2
Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, 8200 Aarhus N, Denmark.
3
Department of Cardiology, Aarhus University Hospital, Skejby, Brendstrupgårdsvej 100, 8200 Aarhus N, Denmark.

Abstract

BACKGROUND:

As proxies for local and remote ischemic preconditioning, we examined whether preinfarction angina pectoris and intermittent claudication influenced mortality following myocardial infarction.

METHODS:

Using medical registries, we conducted a nationwide population-based cohort study of all first-time myocardial infarction patients in Denmark during 2004-2012 (n=70,458). We computed all-cause and coronary mortality rate ratios (MRRs). We categorized time between angina/claudication presentation and subsequent myocardial infarction as 0-14, 15-30, 31-90, and > 90 days. We adjusted for age, sex, coronary intervention, comorbidities, and medication use.

RESULTS:

Among all myocardial infarction patients, 18.4% had prior angina and 3.8% had prior intermittent claudication. Compared to patients without prior angina, the adjusted 30-day coronary MRR was 0.85 (95% confidence interval (CI): 0.80-0.92) for stable and 0.68 (95% CI: 0.58-0.79) for unstable angina patients. The mortality reduction increased when angina presented close to myocardial infarction and was higher for unstable than for stable angina. Thus, the 30-day coronary MRR was 0.72 (95% CI: 0.51-1.02) for stable angina and 0.35 (95% CI: 0.17-0.73) for unstable angina presenting within 14 days before MI. The results were robust for all-cause mortality and in numerous subgroups, including women, diabetics, patients treated with PCI, and patients treated with and without cardioprotective drugs. Preinfarction intermittent claudication was associated with higher short- and long-term mortality compared to patients without intermittent claudication.

CONCLUSIONS:

Preinfarction angina reduced 30-day mortality, particularly when unstable angina closely preceded MI. Preinfarction intermittent claudication was associated with increased short- and long-term mortality.

KEYWORDS:

Angina pectoris; Intermittent claudication; Ischemic preconditioning; Mortality; Myocardial infarction

PMID:
25846654
DOI:
10.1016/j.ijcard.2015.03.328
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center