Abstract 14843: Frequency of Angina After Acute Myocardial Infarction Among Patients With Nonobstructive Coronary Artery Disease
Background: Patients who present with a myocardial infarction (MI) and have nonobstructive CAD (nonobs-CAD) are at increased risk for recurrent ischemic events. As these patients do not have major flow-limiting coronary stenoses, the frequency of angina after MI among patients with nonobs-CAD may differ from patients with obs-CAD.
Methods: Among MI patients who underwent angiography, we assessed angina during hospitalization and 1, 6, and 12M post-MI using the Seattle Angina Questionnaire; angina frequency was categorized as none vs any (score=100 vs <100). Nonobs-CAD was defined as all epicardial stenoses <70%, left main <50%, and no PCI or CABG. A hierarchical, multivariable repeated measures model assessed the independent association of nonobs-CAD with angina. A second model examined factors associated with angina among patients with nonobs-CAD.
Results: Among 5322 MI patients from 31 US hospitals (mean age 59, 68% male), 7.2% had nonobs-CAD. Patients with nonobs-CAD (vs obs-CAD) were more likely female (57% vs 30%), non-white (51% vs 23%), presented with NSTEMI (87% vs 50%), and had lower peak troponin (median 2.4 ng/mL vs 7.8). Patients with nonobs-CAD had less angina prior to MI but more angina at follow-up (Figure). They also had worse disease-specific and generic quality of life (SF12) (p<0.002 for all comparisons at 12M). In the multivariable repeated measures model, the risk for post-MI angina was similar in patients with nonobs-CAD vs. obs-CAD (OR 0.91, 95% CI 0.79-1.05). The only independent predictor of angina among patients with nonobs-CAD was depression (OR 1.29 per 5 points on PHQ9, 95% CI 1.17-1.43).
Conclusions: Following MI, patients with nonobs-CAD experience a burden of angina that is at least as high as those with obs-CAD, with 1 in 4 patients reporting angina at 12M. As these patients are not candidates for revascularization, non-invasive strategies to reduce angina burden could have a significant impact on their health status and quality of life.
- © 2013 by American Heart Association, Inc.