Influencia de la angina preinfarto en la semana previa en la morbimortalidad cardiovascular tardía tras el alta hospitalaria.

Abstract

La angina preinfarto precoz (semana previa) se asocia a una reducción de las complicaciones cardiovasculares en la fase aguda del infarto, pero es escasa la información sobre su relación con el pronóstico tras la fase hospitalaria (muerte cardiovascular y desarrollo de insuficiencia cardiaca e isquemia miocárdica). Estudiamos a 290 pacientes consecutivos ingresados con un primer infarto, 107 con angina precoz (36,9%) y 183 sin ella. Se excluyó a los pacientes con antecedentes de cardiopatía isquémica de más de 1 semana o cardiopatía estructural de base. No se aprecian diferencias en las características basales de ambos grupos. No hay diferencias en las complicaciones cardiovasculares tras el alta hospitalaria (mortalidad cardiovascular, 7 frente a 12,6%; p = 0,3), insuficiencia cardiaca (7,4 frente a 11,6%; p = 0,2) o isquemia miocárdica (infarto o angina inestable, 41,2 frente a 31,3%; p = 0,3) que motiven ingreso hospitalario. La angina precoz no es un factor asociado a complicaciones cardiovasculares tras el alta hospitalaria (odds ratio = 0,75; intervalo de confianza del 95%, 0,51-1,11; p = 0,15).The occurrence of angina in the week preceding myocardial infarction is associated with a reduction in cardiovascular complications in the acute phase. However, little is known about it relationship with prognosis after hospitalization (e.g., cardiovascular death and the development of heart failure or ischemic cardiomyopathy). The study included 290 consecutive patients admitted for a first myocardial infarction: 107 (36.9%) had preceding angina while 183 did not. Those with a history of ischemic cardiomyopathy of more than 1 week or structural cardiopathy were excluded. There was no difference in baseline characteristics between the two groups. Moreover, there was no difference in the rates of cardiovascular complications after hospital discharge: cardiovascular death (7% vs. 12.6%; P=.3), heart failure (7.4% vs. 11.6%; P=.2), and myocardial ischemia, including myocardial infarction and unstable angina, requiring hospitalization (41.2% vs. 31.3%; P=.3). The occurrence of angina in the week before a first myocardial infarction did not influence cardiovascular complications after hospital discharge (odds ratio = 0.75 [0.51-1.11]; P=.15).