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      Effect of preinfarction angina pectoris on long-term survival in patients with ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention.

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          Abstract

          The influence of preinfarction angina pectoris (AP) on long-term clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) remains controversial. In 5,429 patients with acute myocardial infarction (AMI) enrolled in the Coronary Revascularization Demonstrating Outcome Study in Kyoto AMI Registry, the present study population consisted of 3,476 patients with STEMI who underwent primary PCI within 24 hours of symptom onset and in whom the data on preinfarction AP were available. Preinfarction AP defined as AP occurring within 48 hours of hospital arrival was present in 675 patients (19.4%). Patients with preinfarction AP was younger and more often had anterior AMI and longer total ischemic time, whereas they less often had history of heart failure, atrial fibrillation, and shock presentation. The infarct size estimated by peak creatinine phosphokinase was significantly smaller in patients with than in patients without preinfarction AP (median [interquartile range] 2,141 [965 to 3,867] IU/L vs 2,462 [1,257 to 4,495] IU/L, p <0.001). The cumulative 5-year incidence of death was significantly lower in patients with preinfarction AP (12.4% vs 20.7%, p <0.001) with median follow-up interval of 1,845 days. After adjusting for confounders, preinfarction AP was independently associated with a lower risk for death (hazard ratio 0.69, 95% confidence interval 0.54 to 0.86, p = 0.001). The lower risk for 5-year mortality in patients with preinfarction AP was consistently observed across subgroups stratified by total ischemic time, initial Thrombolysis In Myocardial Infarction flow grade, hemodynamic status, infarct location, and diabetes mellitus. In conclusion, preinfarction AP was independently associated with lower 5-year mortality in patients with STEMI who underwent primary PCI.

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          Author and article information

          Journal
          Am. J. Cardiol.
          The American journal of cardiology
          Elsevier BV
          1879-1913
          0002-9149
          Oct 15 2014
          : 114
          : 8
          Affiliations
          [1 ] Department of Cardiovascular Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan.
          [2 ] Department of Cardiovascular Medicine, Kyoto University, Shogoin, Sakyo-ku, Kyoto, Japan. Electronic address: hishiomi@kuhp.kyoto-u.ac.jp.
          [3 ] Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
          [4 ] Department of Cardiology, National Hospital Organization Kyoto Medical Center, Fushimi-ku, Kyoto, Japan.
          [5 ] Division of Cardiology, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan.
          [6 ] Division of Cardiology, Tenri Hospital, Tenri, Nara, Japan.
          [7 ] Department of Cardiology, Kokura Memorial Hospital, Kitakyushu, Japan.
          [8 ] Department of Cardiology, Kurashiki Central Hospital, Kurashiki, Okayama, Japan.
          [9 ] Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Otsu, Shiga, Japan.
          Article
          S0002-9149(14)01499-4
          10.1016/j.amjcard.2014.07.038
          25159235
          5c78106f-b82e-4a21-ac41-316400b72463
          History

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