title: Effect of preinfarction angina pectoris on long-term survival in patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention.
abstract: The influence of preinfarction angina pectoris (AP) on long-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) remains controversial. In 5,429 patients with acute myocardial infarction (AMI) enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto AMI Registry, the present study population consisted of 3,476 patients with STEMI who underwent primary PCI within 24 hours of symptom onset and in whom the data on preinfarction AP were available. Preinfarction AP defined as AP occurring within 48 hours of hospital arrival was present in 675 patients (19.4%). Patients with preinfarction AP was younger and more often had anterior AMI and longer total ischemic time, whereas they less often had history of heart failure, atrial fibrillation, and shock presentation. The infarct size estimated by peak creatinine phosphokinase was significantly smaller in patients with than in patients without preinfarction AP (median [interquartile range] 2,141 [965 to 3,867] IU/L vs 2,462 [1,257 to 4,495] IU/L, p <0.001). The cumulative 5-year incidence of death was significantly lower in patients with preinfarction AP (12.4% vs 20.7%, p <0.001) with median follow-up interval of 1,845 days. After adjusting for confounders, preinfarction AP was independently associated with a lower risk for death (hazard ratio 0.69, 95% confidence interval 0.54 to 0.86, p = 0.001). The lower risk for 5-year mortality in patients with preinfarction AP was consistently observed across subgroups stratified by total ischemic time, initial Thrombolysis In Myocardial Infarction flow grade, hemodynamic status, infarct location, and diabetes mellitus. In conclusion, preinfarction AP was independently associated with lower 5-year mortality in patients with STEMI who underwent primary PCI.
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Taniguchi
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan. Electronic address: hishiomi@kuhp.kyoto-u.ac.jp.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Shiomi
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Toyota
authors.affiliation: Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Morimoto
authors.affiliation: Department of Cardiology, National Hospital Organization Kyoto Medical Center, Fushimi-ku, Kyoto, Japan.
authors.forename: Masaharu
authors.initials: M
authors.lastname: Akao
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Nakatsuma
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan.
authors.forename: Koh
authors.initials: K
authors.lastname: Ono
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan.
authors.forename: Takeru
authors.initials: T
authors.lastname: Makiyama
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Shizuta
authors.affiliation: Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Furukawa
authors.affiliation: Division of Cardiology, Tenri Hospital, Tenri, Nara, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Nakagawa
authors.affiliation: Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
authors.forename: Kenji
authors.initials: K
authors.lastname: Ando
authors.affiliation: Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kadota
authors.affiliation: Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
authors.forename: Minoru
authors.initials: M
authors.lastname: Horie
authors.affiliation: Department of Cardiovascular Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kimura
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D002423:Cause of Death / Q000639:trends; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007564:Japan / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D057234:Preoperative Period; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome