title: Change in Angina Symptom Status After Acute Myocardial Infarction and Its Association With Readmission Risk: An Analysis of the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) Registry.
abstract: Angina is common both before and after myocardial infarction (MI). Whether the change in angina status within the first 30 days after MI is associated with subsequent readmission and angina persistence is unknown.
  
  
  
  We studied 2915 MI patients enrolled at 24 hospitals in the Translational Research Investigating Underlying Disparities in Acute Myocardial Infarction Patients' Health Status (TRIUMPH) registry. Angina before and 30 days after MI was assessed with the Seattle Angina Questionnaire. Patients were divided into angina-free pre- and post-MI (-/-), resolved angina (+/-), new angina (-/+), and persistent angina (+/+) groups. Multivariable proportional hazards and hierarchical modified Poisson models were performed to assess the association of each group with all-cause readmission, readmission for MI or unplanned revascularization, and angina persistence at 1 year. Overall, 1293 patients (44%) had angina before their MI and 849 (29%) reported angina within 30 days of discharge. Patients with post-MI angina were more likely to be younger, nonwhite, and uninsured. Compared with patients who were angina-free pre- and post-MI, 1-year all-cause readmission risks were significantly higher for patients with persistent angina (hazard ratio [HR], 1.35; 95% CI 1.06-1.71) or new angina (HR, 1.40; 95% CI, 1.08-1.82). At 1 year, angina was present in 22% of patients and was more likely if angina was persistent (HR, 3.55; 95% CI, 3.05-4.13) or new (HR, 3.38; 95% CI, 2.59-4.42) at 30 days compared with patients who were angina-free pre- and post-MI.
  
  
  
  Post-MI angina, whether new or persistent, is associated with higher likelihood of readmission. Prioritizing post-MI angina management is a potential means of improving 1-year outcomes.
authors.affiliation: Duke Clinical Research Institute, Durham, NC Department of Medicine, Duke University, Durham, NC jacob.doll@duke.edu.
authors.forename: Jacob A
authors.initials: JA
authors.lastname: Doll
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO University of Missouri-Kansas City, Kansas City, MO.
authors.forename: Fengming
authors.initials: F
authors.lastname: Tang
authors.affiliation: Department of Medicine, Washington University School of Medicine, St. Louis, MO.
authors.forename: Sharon
authors.initials: S
authors.lastname: Cresci
authors.affiliation: VA Eastern Colorado Health Care System, Denver, CO University of Colorado School of Medicine, Aurora, CO.
authors.forename: P Michael
authors.initials: PM
authors.lastname: Ho
authors.affiliation: VA Eastern Colorado Health Care System, Denver, CO University of Colorado School of Medicine, Aurora, CO.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: Saint Luke's Mid America Heart Institute, Kansas City, MO University of Missouri-Kansas City, Kansas City, MO.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Duke Clinical Research Institute, Durham, NC Department of Medicine, Duke University, Durham, NC.
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
mesh_terms: D000704:Analysis of Variance; D000787:Angina Pectoris / Q000209:etiology*; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D011795:Surveys and Questionnaires
keywords: angina; coronary disease; myocardial infarction