Effect of prodromal angina pectoris on altering the relation between time to reperfusion and outcomes after a first anterior wall acute myocardial infarction

To test the hypothesis that prodromal angina may favorably alter the relation between time to reperfusion and outcomes after acute myocardial infarction (AMI), we studied 658 patients with a first anterior AMI: 200 patients with early reperfusion (time to reperfusion ≤2 hours), 205 patients with intermediate reperfusion (2 to 4 hours), 197 patients with late reperfusion (4 to 12 hours), and 56 patients without reperfusion (no reperfusion). Serial measurements of left ventricular ejection fraction (LVEF) were obtained before reperfusion therapy and before hospital discharge in 450 patients. Thirty-day mortality (3%, 4%, 8%, and 27% in early, intermediate, late, and no reperfusion, respectively, p <0.001) and the change in LVEF (8 ± 14%, 6 ± 13%, 6 ± 12%, and -1 ± 9%, respectively, p <0.001) were dependent on time to reperfusion and were worse if reperfusion was not obtained. In early reperfusion, 30-day mortality (3% vs 2%, p = 0.88) and improvement of LVEF (9 ± 14% vs 8 ± 14%, p = 0.59) were not significantly different between patients with prodromal angina and patients without prodromal angina. In intermediate or late reperfusion, prodromal angina was associated with lower 30-day mortality (3% vs 8%, p = 0.049) and a greater improvement in LVEF (8 ± 13% vs 5 ± 13%, p = 0.037). In no reperfusion, 30-day mortality (25% vs 27%, p = 0.87) and the change in LVEF (-1 ± 11% vs -1 ± 9, p = 0.87) were poor, regardless of prodromal angina. These findings suggest that prodromal angina might favorably alter the relation between time to reperfusion and outcomes after AMI. However, prodromal angina did not afford any benefits if reperfusion was not achieved.