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Angina burden after MI similar between patients with, without obstructive CAD
Patients without obstructive CAD after an MI had similar angina burden to those with obstructive CAD in an analysis published in European Heart Journal.
Strategies to address quality of life and health are necessary to address the burden of angina in this patient population, as they are ineligible for revascularization, the researchers wrote.
Anna Grodzinsky, MD, a cardiovascular fellow at Saint Luke’s Mid America Heart Institute in Kansas City, Missouri, and colleagues evaluated data collected from two prospective, observational registries, TRIUMPH and PREMIER, on 5,539 patients with MI treated at 31 hospitals throughout the United States. All of the patients underwent angiography and were assessed for angina and general health status at baseline and 1, 6 and 12 months. The cohort had a mean age of 59.6 years and was 68% male.
Obstructive CAD, defined as epicardial coronary stenosis of at least 70% or left main stenosis of at least 50%, was absent on angiography in 6.9% of cases. These patients were more frequently female and nonwhite and were more likely to have non-STEMI than those with obstructive CAD.
Angina was less common among patients without obstructive CAD during the 4 weeks before MI (42.5% of patients vs. 48%; P = .038), but this difference did not persist at the 12-month follow-up (24.6% vs. 21.4%; P = .199).
Patients without obstructive CAD were at similar risk for angina after MI than those with obstructive CAD after adjustment for confounders (incidence rate ratio [IRR] = 0.89; 95% CI, 0.77-1.02). Sensitivity analyses in which patients with prior HF, troponin levels less than 1 ng/mL and no obstructive CAD were excluded, and in which obstructive CAD was defined as epicardial stenosis greater than 50%, each yielded similar results.
Factors associated with the presence of angina among those with no obstructive CAD included depression (IRR = 1.28; 95% CI, 1.17-1.41 per 5 points on the Patient Health Questionnaire) and avoiding care due to treatment costs (IRR = 1.34; 95% CI, 1.02-1.74). These associations were not present in analysis including all patients (P = .43 for interaction for depression and P = .76 for care avoidance).
In a subanalysis of 3,440 patients enrolled in the TRIUMPH registry with evaluable data on rehospitalization, rates of both all-cause hospitalization and hospitalization due to chest pain were similar between those with and without obstructive CAD, the researchers wrote (P = .64 and P = .07, respectively).
“Our findings highlight the importance of aggressive medical therapy and follow-up in patients with MI and no obstructive CAD, in order to potentially reduce their burden of angina, improve quality of life and prevent rehospitalizations,” Grodzinsky said in a press release. “Angina is a potentially modifiable condition and, therefore, patient symptoms could be improved, as well as health care costs.” – by Adam Taliercio
Disclosure: Grodzinsky reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.