Abstract 10449: Pre-Infarction Angina and Short-term Outcomes in Non St Segment Elevation Myocardial Infarction: Data From the Rico Survey.
Background: The presence of preinfarction angina (PIA) has been shown to confer cardioprotection after ST segment elevation myocardial infarction (MI). However, the impact of PIA in non ST segment elevation (NSTEMI) remains to be determined.
Methods: From the obseRvatoire des Infarctus de Côte d'Or (RICO) survey, 1789 consecutive patients admitted in ICU with a first NSTEMI were included. Patients who experienced chest pain, chest discomfort or left arm and jaw pain <7 days before the episode leading to admission were defined as having PIA. Prehospital resuscitated cardiac arrest (RCA), incidence of in-hospital ventricular arrhythmias (VA) (ventricular fibrillation or tachychardia), heart failure (killip class>1) and 30-day mortality were also collected.
Results: Among the 1789 patients included, 564 (26%) patients presented PIA. Baseline clinical characteristics and GRACE risk score were similar for the 2 groups. However, PIA was associated with a lower CRP on admission (5.1(2.0–12.0) vs. 6.0(2.4–19.1) mg/L, p=0.002), when compared with the group without PIA. Moreover, a lower peak creatine kinase, as a reflect of infarct size (223(109–486) vs. 270(133–754) IU/L, p<0.001), a lower peak troponin Ic (3.7(0.9–12) vs. 5.0(1.3–18.4) μg/L, p<0.001), were observed in the PIA group. Patients with PIA were admitted with less pre-hospital RCA (1.4% vs. 3.5%, p=0.02) and developed fewer VA during the hospital stay (2.7% vs. 6.6%, p<0.001). There was a trend toward a decrease in hospital heart failure and 30-day death in patients with PIA vs without PIA (21.3% vs. 25.4%, p=0.067 and 4.4% vs 6.1%, p=0.182, respectively).
Conclusion: From this large contemporary observational study, PIA is observed in about ¼ of patients admitted for a first NSTEMI, and is associated with improved left ventricular function, less pre-hospital RCA, and decreased in-hospital VA. These findings suggest that identifying lack of PIA in patients admitted for a NSTEMI could help for risk stratification, in particular for ventricular arrhythmias.
- © 2010 by American Heart Association, Inc.