Angina pectoris in patients with a history of myocardial infarction.

The existence of a history of myocardial infarction (MI) in patients with angina pectoris is frequently associated with certain patient characteristics, including an established history of coronary artery disease (CAD), depressed left ventricular function in some patients and multivessel coronary disease. Angina is a symptom which reveals the persistence or recurrence of myocardial ischaemia. It is uncertain whether persistent myocardial ischaemia after MI is an adverse prognostic factor. In fact, the most important known prognostic factor is left ventricular function. Before choosing an anti-anginal therapy in patients with a history of MI, coronary angiography should be performed in order to investigate the possibility of left main or multivessel CAD. Angina patients with impaired left ventricular function may benefit from revascularization but the prognostic value of percutaneous transluminal coronary angioplasty in these patients remains to be assessed. Medical anti-anginal therapy for symptoms, added to routine background treatment, is indicated when the results of revascularization are unsatisfactory or if there is an absence of indication, or a contra-indication, for revascularization procedures. Particular attention should be paid to the possible additive negative inotropic or chronotropic effects of beta-blockers and certain calcium antagonists on the myocardium.