One year after heart attack, chest pain remains for many


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.  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 depression.

"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 . 168[12]: pp. 1310 - 1316.

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Section Issues On Medicine: Cardiology