Prediction of infarction-related artery occlusion and multivessel disease in postinfarction angina.
CONCLUSIONS
To investigate the predictive value of clinical data for infarction-related artery (IRA) occlusion and multivessel coronary disease in postinfarction angina (PIA), we studied 181 consecutive patients presenting PIA following a first uncomplicated ST elevation AMI. Multivariate analysis showed ECG changes during PIA and the absence of thrombolytic therapy as independent predictors of IRA occlusion. Independent clinical predictors of multivessel coronary disease were age, previous history of angina and the number of cardiovascular risk factors. We conclude that reversible ECG changes during PIA correlated to IRA occlusion but failed to predict a multivessel coronary disease.


OBJECTIVE
To identify clinical variables predictive of infarction-related artery (IRA) occlusion and multivessel coronary disease in patients with postinfarction angina pectoris (PIA) after a first uncomplicated acute myocardial infarction (AMI).


METHODS
We studied 181 consecutive patients with PIA following a first uncomplicated AMI. Clinical variables included cardiovascular risk factors, clinical history of angina before the event of inclusion, use of thrombolytic therapy in the previous AMI, ST-T changes during PIA, time to onset, number of episodes and delay to angiography after PIA. Angiographic variables were IRA TIMI flow, number of diseased vessels and ventricular function.


RESULTS
The IRA was occluded in 67 patients with PIA (37.0%). Reversible ECG changes during PIA were detected in 121 patients (67.0%): 79 cases (43.6%) with ST/T elevation and 42 cases (23.2%) with ST/T depression. Multivariate logistic regression analysis showed ECG changes during PIA (OR 3.12 CI 95% 1.48-6.54, p<0.01) and the absence of thrombolytic therapy (OR 2.21 95% CI 1.11-4.43, p<0.05) as independent predictors of IRA occlusion. We found multivessel coronary disease in 89 patients (49.2%) without any correlation to ECG changes during PIA. Independent clinical predictors of multivessel coronary disease were age (OR 1.03 95% CI 1.01-1.06, p<0.05), previous history of angina (OR 2.37 95% CI 1.06-5.28, p<0.05) and the number of cardiovascular risk factors (OR 1.37 95% CI 0.97-1.92, p=0.07).


CONCLUSIONS
ECG changes during PIA was correlated to IRA occlusion in spite of previous thrombolytic therapy but failed to predict a multivessel coronary disease in our patients.
Valenzuela
L F
LF
Virgen Macarena University Hospital, Seville, Spain. lfvg@telefonica.net
Vázquez
R
R
Fournier
J A
JA
Cubero
J
J
Maraví
J
J
Cruz-Fernández
J M
JM
Kaski
J C
JC
D000328:Adult; D017677:Age Distribution; D000787:Angina Pectoris / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D015331:Cohort Studies; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D023903:Coronary Restenosis / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications*; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods