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Prevalence and Associated Findings

Thomas M. Maddox, MD, SM; Kimberly J. Reid, MS; John A. Spertus, MD, MPH; Murray Mittleman, MD, PhD; Harlan M. Krumholz, MD, SM; Susmita Parashar, MD, MPH; P. Michael Ho, MD, PhD; John S. Rumsfeld, MD, PhD

Arch Intern Med. 2008;168(12):1310-1316.

Background  Eradication of angina is a primary goal of care after myocardial infarction (MI). However, the prevalence of angina 1 year after MI and factors associated with it are unknown.

Methods  From January 1, 2003, through June 28, 2004, 2498 patients with acute MI were recruited from 19 hospitals in the United States. Among this multicenter cohort of patients, angina was measured by the Seattle Angina Questionnaire 1 year after hospitalization for MI. Multivariate regression modeling identified the sociodemographic factors, clinical history, MI presentation, inpatient treatments, and outpatient treatments associated with 1-year angina, adjusted for site.

Results  Of 1957 patients in the cohort, 389 (19.9%) reported angina 1 year after MI. After multivariate analysis, patients with 1-year angina were more likely to be younger (relative risk [RR] per 10-year decrease, 1.19; 95% confidence interval [CI], 1.09-1.30), to be nonwhite males (RR, 1.50; 95% CI, 1.16-1.96), to have had prior angina (RR, 1.78; 95% CI, 1.54-2.06), to have undergone prior coronary artery bypass graft surgery (RR, 1.92; 95% CI, 1.51-2.44), and to experience recurrent rest angina during their hospitalization (RR, 1.54; 95% CI, 1.22-1.93). Among the outpatient variables, patients with 1-year angina were more likely to continue smoking (RR, 1.23; 95% CI, 1.02-1.48), to undergo revascularization after index hospitalization (percutaneous coronary intervention or coronary artery bypass graft) (RR, 1.37; 95% CI, 1.09-1.73), and to have significant new (RR, 1.96; 95% CI, 1.34-2.87), persistent (RR, 1.88; 95% CI, 1.29-2.75), or transient (RR, 1.77; 95% CI, 1.49-2.11) depressive symptoms.

Conclusions  Angina occurs in nearly 1 of 5 patients 1 year after MI. It is associated with several modifiable factors, including persistent smoking and depressive symptoms.

Author Affiliations: Denver Veterans Affairs Medical Center/Department of Medicine, University of Colorado Denver (Drs Maddox, Ho, and Rumsfeld); Mid-America Heart Institute, Kansas City, Missouri (Ms Reid and Dr Spertus); Cardiovascular Epidemiology Research Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Mittleman); Section of Cardiovascular Medicine and the Robert Wood Johnson Clinical Scholars Program, Department of Medicine, and Section of Health Policy and Administration, School of Public Health, Yale University School of Medicine, and Center for Outcomes Research and Evaluation, Yale–New Haven Hospital, New Haven, Connecticut (Dr Krumholz); and Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia (Dr Parashar).

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