Course of angina pectoris after an acute coronary event

The prognostic significance of angina pectoris experienced during the first month following acute myocardial infarction

BACKGROUND

Angina pectoris accompanied by transient ST-segment changes during the in-hospital phase of acute myocardial infarction (AMI) is a well established marker of subsequent cardiac death and reinfarction.

HYPOTHESIS

This study was undertaken to record the prognostic significance of angina pectoris experienced during the first month following discharge from AMI.

METHODS

In all, 803 patients included in the placebo arm of the Danish Verapamil Infarction Trial II were followed up for 18 months in 20 coronary care units in Denmark. The patients were randomized to placebo and were still on study treatment 1 month after discharge. Of these patients, 311 (39%) reported chest pain during the first month following discharge.

RESULTS

Patients with angina pectoris had a significantly increased risk of reinfarction [hazard 1.71; 95%-confidence limit (CL): 1.09, 2.69] and increased mortality risk which, however, only reached borderline statistical significance (hazard 1.52; 95%-CL: 0.96, 2.40). When patients were subdivided according to both angina pectoris and heart failure, those with one or both of these risk markers had significantly increased mortality (p 0.03) and reinfarction (p 0.02) rates compared with patients free of both angina pectoris and heart failure.

CONCLUSION

Patients with postinfarction angina pectoris have a significantly increased morbidity risk.

Randomised controlled trial of health promotion in general practice for patients at high cardiovascular risk

OBJECTIVE

To assess the value of health education for patients with angina in reducing risk factors for cardiovascular disease and lessening the effect of angina on everyday activities.

DESIGN

Randomised controlled trial of personal health education given every four months.

SETTING

18 general practices in the greater Belfast area.

SUBJECTS

688 patients aged less than 75 years and known to have had angina for at least six months; 342 randomised to receive education and 346 to no education.

MAIN OUTCOME MEASURES

Restriction of everyday activities, dietary habit, smoking habit, frequency of physical exercise; blood pressure, body mass index, and serum total cholesterol concentration at entry to trial and after two years.

RESULTS

317 in the intervention group and 300 in the control group completed the trial. At the two year review more of the intervention group (140, 44%) reported taking daily physical exercise than the control group (70, 24%). The intervention group also reported eating a healthier diet than the control group and less restriction by angina in any everyday activity. No significant differences were found between the groups in smoking habit, systolic or diastolic blood pressure, cholesterol concentration, or body mass index.

CONCLUSION

Despite having no significant effect on objective cardiovascular risk factors, personal health education of patients with angina seems to increase exercise and improve dietary habits and is effective in lessening the restriction of everyday activities.