title: Association Between Preinfarction Angina and Angiographic Findings in Non-ST-Segment Elevation Myocardial Infarction.
abstract: BACKGROUND
  The association between preinfarction angina and angiographic findings has not been elucidated in patients with non-ST-segment elevation myocardial infarction (NSTEMI).
  
  
  OBJECTIVE
  Patients with preinfarction angina have favorable angiographic findings.
  
  
  METHODS
  This retrospective study analyzed 481 patients who underwent coronary angiography within 5 days of presenting NSTEMI. Preinfarction angina was defined as experiencing ≥1 chest-pain episode within 7 days prior to admission. Infarct size was measured as the peak cardiac troponin I (cTnI) level, and large myocardial infarction (MI) was defined as a peak cTnI level >85th percentile value in the study population. Infarct-related artery (IRA) patency was defined as Thrombolysis In Myocardial Infarction grade 2 or 3 flow. Clinical and angiographic characteristics and in-hospital mortality were compared between patients with and without preinfarction angina.
  
  
  RESULTS
  Among 481 patients, 200 (42%) had preinfarction angina. Preinfarction angina was associated with smaller infarct size, indicated by lower peak cTnI levels (P = 0.006) and lower incidence of large MI (P = 0.02), and IRA patency (P = 0.03). There was no significant difference in in-hospital mortality. On multivariate analysis, both preinfarction angina (odds ratio: 0.53, 95% confidence interval: 0.29-0.94, P = 0.03) and IRA patency (odds ratio: 0.30, 95% confidence interval: 0.17-0.52, P < 0.001) were independent negative predictors of large MI.
  
  
  CONCLUSIONS
  Our study demonstrates that preinfarction angina is a predictor of smaller infarct size and infarct-related artery patency in NSTEMI patients, suggesting that NSTEMI patients presenting without preinfarction angina are at increased risk of developing a large MI.
authors.affiliation: Department of Internal Medicine, Mount Sinai Beth Israel, New York, New York.
authors.forename: Naoki
authors.initials: N
authors.lastname: Misumida
authors.affiliation: Department of Internal Medicine, Mount Sinai Beth Israel, New York, New York.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Kobayashi
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel, New York, New York.
authors.forename: Madeeha
authors.initials: M
authors.lastname: Saeed
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel, New York, New York.
authors.forename: John T
authors.initials: JT
authors.lastname: Fox
authors.affiliation: Department of Cardiology, Mount Sinai Beth Israel, New York, New York.
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Kanei
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000097:blood / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D009206:Myocardium / Q000378:metabolism / Q000473:pathology; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D019210:Troponin I / Q000097:blood; D014654:Vascular Patency
chemical_list: D015415:Biomarkers; D019210:Troponin I