ANTECEDENT ANGINA-PECTORIS PREDICTS WORSE OUTCOME AFTER MYOCARDIAL-INFARCTION IN PATIENTS RECEIVING THROMBOLYTIC THERAPY - EXPERIENCE GLEANED FROM THE INTERNATIONAL TISSUE PLASMINOGEN-ACTIVATOR STREPTOKINASE MORTALITY TRIAL

The significance of antecedent angina in predicting clinical outcome was assessed in 8,329 patients with acute myocardial infarction who received thrombolytic therapy with either recombinant tissue-type plasminogen activator or streptokinase. There were 2,370 patients with antecedent angina for >1 month, 1,512 patients with antecedent angina for less-than-or-equal-to 1 month and 4,447 patients with no antecedent angina. The longer the duration of angina, the worse the baseline characteristics in the three groups: the mean patient age was 65 versus 62 versus 61 years, respectively (p < 0.0001); the rate of previous myocardial infarction was 37 % versus 18 % versus 10 % (p < 0.0001); and the rate of hypertension was 40 % versus 31 % versus 27 % (p < 0.0001). Antecedent angina was associated with a longer hospital stay (11.3 and 11.7 days vs. 10.8 days, p < 0.0001), a higher incidence of bypass surgery (2.2 % vs. 1.2 % vs. 0.7 %, p = 0.0001), a worse Killip class at discharge (10.6 % of patients in class >1 vs. 8.7 % vs. 6.4 %, p = 0.0001), and a higher hospital and 6-month mortality (12.1 % and 18 % vs. 8.9 % and 11.6 % vs. 6.6 % and 9.2 %, respectively, p < 0.0001). A multivariate analysis taking into account all baseline characteristics confirmed the independent association of antecedent angina with mortality, with a relative risk of 1.4 to 1.47 (p < 0.0011). Antecedent angina predicts a worse clinical outcome and a more intense use of medical resources in patients with acute myocardial infarction receiving thrombolytic therapy.