[Prognostic effect of angina before acute myocardial infarction in elderly patients].

OBJECTIVE

The present study examined whether angina 48 h before acute myocardial infarction provided protection in early and adult patients. To investigate the effect of ischemic preconditioning in senescent heart.

METHODS

We retrospectively verified whether antecedent angina within 48 h myocardial infarction exerted a beneficial effect on in-hospital outcomes in adult(< 60 years old, n = 68) and elderly (> or = 60 years old, n = 118) patients.

RESULTS

In-hospital congestive heart failure was more frequent in adult patients without than in those with previous angina(16.7% vs 2.6%, P < 0.05), as were cardiogenic shock and death(23.3% vs 5. 3%, P < 0.05) and the combined end points(in-hospital congestive heart failure and shock or death) (40.0% vs 7.9%, P < 0.01). In contrast, the presence or absence of previous angina before acute myocardial infarction in elderly patients seemed to have no obvious influence, the incidence of in-hospital congestive heart failure(17.7% vs 20.0%, P > 0.05), shock and death(23.5% vs 20.3%, P > 0.05) and combined end points(41.2% vs 40.0%, P > 0.05). But the elderly patients with angina showed a significantly smaller infarct size compared with elderly patients without angina, the long-term cardiogenic death was more frequent in elderly patients without than in those with previous angina(18.0% vs 5.9%, P < 0.05).

CONCLUSIONS

The presence of angina before acute myocardial infarction seems to confer significant protection against in-hospital outcomes in adults; this effect seems to be present in elderly patients. This study suggests that the protection afforded by angina in adult and elderly patients may involve the occurrence of ischemic preconditioning.