title: Angina Frequency After Acute Myocardial Infarction In Patients Without Obstructive Coronary Artery Disease.
abstract: BACKGROUND
  Myocardial infarction (MI) patients without obstructive coronary artery disease (CAD) are at increased risk for recurrent ischemic events, but angina frequency post-MI has not been described.
  
  
  RESULTS
  Among MI patients who underwent angiography, we assessed angina at baseline, 1, 6, and 12 months using the Seattle Angina Questionnaire (SAQ). A hierarchical repeated measures modified Poisson model assessed the association between the absence of obstructive CAD (defined as epicardial stenoses >70% or left main >50%) and angina. Among 5539 MI patients from 31 US hospitals (mean age 60, 68% male), 6.9% had no angiographic obstructive CAD. More patients without obstructive CAD (vs. obstructive CAD) were female (57% vs 30%), non-white (51% vs 24%) and had NSTEMI (87% vs 51%). In unadjusted analyses, patients without obstructive CAD had less angina prior to MI but more angina and worse health status post-discharge. After adjustment for socio-demographic and clinical factors, the risk of post-MI angina was similar in patients without vs. with obstructive CAD (IRR=0.89, 95% CI 0.77-1.02). Among patients without obstructive CAD, depression and self-reported avoidance of care due to cost were independently associated with angina (IRR=1.28 per 5 points on PHQ, 95% CI 1.17-1.41; IRR=1.34, 95% 1.02-1.1.74).
  
  
  CONCLUSIONS
  Following MI, patients without obstructive CAD experience an angina burden at least as high as those with obstructive CAD, affecting 1 in 4 patients at 12 months. As these patients are not candidates for revascularization, other anti-anginal strategies are needed to improve their health status and quality of life.
authors.affiliation: Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO.
authors.forename: Anna
authors.initials: A
authors.lastname: Grodzinsky
authors.affiliation: Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO.
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Arnold
authors.affiliation: Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO.
authors.forename: Kensey
authors.initials: K
authors.lastname: Gosch
authors.affiliation: Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA.
authors.forename: JoAnne M
authors.initials: JM
authors.lastname: Foody
authors.affiliation: The Queen Elizabeth Hospital Discipline of Medicine University of Adelaide and the Central Adelaide Local Health Network Cardiology Stream.
authors.forename: John
authors.initials: J
authors.lastname: Beltrame
authors.affiliation: VA Eastern Colorado Health Care System, Denver, CO; University of Colorado School of Medicine, Denver, CO.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Maddox
authors.affiliation: Division of Cardiology, Department of Medicine, Emory University, Atlanta, GA.
authors.forename: Susmita
authors.initials: S
authors.lastname: Parashar
authors.affiliation: Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, Kansas City, MO.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kosiborod
keywords: Acute myocardial infarction; Angina; Coronary artery disease