One Year After Heart Attack, Chest Pain Remains For Many

About 20% of heart attack patients experience angina (chest pain) one
year after the major cardiac event, according to researchers who have
published a new study in the June 23 issue of Archives of
Internal Medicine.

In both inpatient and outpatient settings, a primary goal of care after
myocardial infarction (MI), commonly known as heart attack, is to the
episodic chest pain known as angina. There has been little or no
research up to this point focusing on the prevalence and treatment of
chest pain that occurs one year after MI.聽 Author Thomas M.
Maddox, M.D., S.M. (Denver Veterans Affairs Medical Center and
University of Colorado Denver) and colleagues note that, “By
identifying these factors, a more complete understanding of those
patients who are at the greatest risk for angina after myocardial
infarction can occur.” In order to treat remaining chest pain and
improve a patient’s ability to exercise among other health-related
quality of life outcomes, it is crucial for doctors to identifying this
population who suffers the greatest angina risk.

The study consisted of 1,957 patients who were selected from January
2003 to June 2004. Researchers asked patient to fill out surveys that
included questions about chest pain occurring one year after MI
hospitalization, sociodemographic information, and details about
clinical and lifestyle factors.

Angina one year after MI hospitalization was reported by almost 20% of
patients (389 of 1,957). Daily chest pain was reported by 1.2% (24 of
1,957), weekly chest pain by 3% (59 of 1,957), and chest pain less than
once a week by 15.6% (306 of 1,957).

Of greater interest, the researchers noted that patients who were
younger, non-white males with a previous history of coronary artery
bypass graft procedure, and those who experienced chest pain while
resting in the hospital after MI were more likely to experience angina
one year after MI. In addition, chest pain after one year was
associated with patients who continued smoking, who underwent surgery
to permit heart blood flow (revascularization) after hospitalization,
and who had significant new, persistent or fleeting symptoms of

“Multiple factors were associated with one-year angina, including
demographic, clinical, inpatient and outpatient characteristics.
Recognition of these relationships will be important in monitoring
at-risk patients after acute myocardial infarction,” conclude Maddox
and colleagues. “In addition, future investigation into modifiable
factors, such as depression and smoking cessation, will be important in
the quest to alleviate angina and improve subsequent cardiac outcomes
among patients after myocardial infarction.”

Angina at 1 Year After Myocardial Infarction: 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
Archives of Internal Medicine (2008). 168[12]:
pp. 1310
– 1316.
Here to View Abstract

Written by: Peter M Crosta

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