Five year prognosis in patients with angina identified in primary care: incident cohort study.
OBJECTIVE
To ascertain the risk of acute myocardial infarction, invasive cardiac procedures, and mortality among patients with newly diagnosed angina over five years.


METHODS
Incident cohort study of patients with primary care data linked to secondary care and mortality data.


METHODS
40 primary care practices in Scotland.


METHODS
1785 patients with a diagnosis of angina as their first manifestation of ischaemic heart disease, 1 January 1998 to 31 December 2001.


METHODS
Adjusted hazard ratios for acute myocardial infarction, coronary artery bypass grafting, percutaneous transluminal coronary angioplasty, death from ischaemic heart disease, and all cause mortality, adjusted for demographics, lifestyle risk factors, and comorbidity at cohort entry.


RESULTS
Mean age was 62.3 (SD 11.3). Male sex was associated with an increased risk of acute myocardial infarction (hazard ratio 2.01, 95% confidence interval 1.35 to 2.97), death from ischaemic heart disease (2.80, 1.73 to 4.53), and all cause mortality (1.82, 1.33 to 2.49). Increasing age was associated with acute myocardial infarction (1.04, 1.02 to 1.06, per year of age increase), death from ischaemic heart disease (1.09, 1.06 to 1.11, per year of age increase), and all cause mortality (1.09, 1.07 to 1.11, per year of age increase). Smoking was associated with subsequent acute myocardial infarction (1.94, 1.31 to 2.89), death from ischaemic heart disease (2.12, 1.32 to 3.39), and all cause mortality (2.11, 1.52 to 2.95). Obesity was associated with death from ischaemic heart disease (2.01, 1.17 to 3.45) and all cause mortality (2.20, 1.52 to 3.19). Previous stroke was associated with all cause mortality (1.78, 1.13 to 2.80) and chronic kidney disease with death from ischaemic heart disease (5.72, 1.74 to 18.79). Men were more likely than women to have coronary artery bypass grafting or percutaneous transluminal coronary angioplasty after a diagnosis of angina; older people were less likely to receive percutaneous transluminal coronary angioplasty. Acute myocardial infarction after a diagnosis of angina was associated with an increased risk of death from ischaemic heart disease and all cause mortality (8.84 (5.31 to 14.71) and 4.23 (2.78 to 6.43), respectively). Neither of the invasive cardiac procedures significantly reduced the subsequent risk of all cause mortality.


CONCLUSIONS
In this sample of people with incident angina from primary care, there were sex differences in survival and age and sex differences in the provision of revascularisation after a diagnosis. Acute myocardial infarction after a diagnosis of angina was strongly predictive of mortality. To minimise adverse outcomes, optimal preventive treatments should be used in patients with angina.
Buckley
Brian S
BS
Department of General Practice, National University of Ireland, Galway, Ireland. bsbuckley@iol.ie
Simpson
Colin R
CR
McLernon
David J
DJ
Murphy
Andrew W
AW
Hannaford
Philip C
PC
D017677:Age Distribution; D000787:Angina Pectoris / Q000401:mortality*; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D002423:Cause of Death; D001026:Coronary Artery Bypass / Q000401:mortality; D005260:Female; D006801:Humans; D008019:Life Style; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality; D017202:Myocardial Ischemia / Q000401:mortality; D009765:Obesity / Q000401:mortality; D011379:Prognosis; D012606:Scotland / Q000453:epidemiology; D017678:Sex Distribution; D012907:Smoking / Q000401:mortality