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From Good Samaritan Hospital, Los Angeles, Calif (R.A.K., T.S., K.P.);
the University of Southern California, Los Angeles (R.A.K., K.P.); Brigham and
Womens Hospital and Harvard Medical School, Boston, Mass (E.M.A., C.P.C.,
C.H.M., E.B.); and Covance Inc, Princeton, NJ (K.Y.).
Correspondence to Robert A. Kloner, MD, PhD, Heart Institute, Good Samaritan Hospital, 1225 Wilshire Blvd, Los Angeles, CA 90017.
Background—The timing of onset of
angina before myocardial infarction in relation to outcome is
unknown.
Methods and Results—We prospectively determined the importance of
the time of onset of preinfarction angina in relation to 30-day
outcomes in the TIMI-9B study from standardized forms. Of the 3002
patients entered into the study, 425 reported angina before their
myocardial infarction. Patients with angina onset within 24 hours of
infarction had a lower 30-day cardiac event rate (mortality, recurrent
myocardial infarction, heart failure, or shock) at 4% than those with
onset of angina >24 hours (17%; P=.030). A history of
any angina alone was not associated with reduced event rate. Peak
creatine kinase levels tended to be lower in the group with angina
within 24 hours. These benefits were not due to higher rates of use of
antianginal medicines or aspirin and were not a consequence of
differences in baseline characteristics or disease states
(hypertension, hypercholesterolemia) among
subgroups.
Conclusions—These temporal observations are consistent
with the concept of preconditioning by preinfarction angina but do not
rule out other mechanisms.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Prospective Temporal Analysis of the Onset of Preinfarction Angina Versus Outcome
An Ancillary Study in TIMI-9B
Key Words: angina • myocardial infarction • trials
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