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RESEARCH PRODUCT

013 Pre-infarction angina and cardiovascular complications in non ST segment elevation myocardial infarction: Data from the RICO survey

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BackgroundThe presence of preinfarction angina (PIA) has been shown to confer cardioprotection after ST segment elevation myocardial infarction (MI). However, the impact of PIA in non ST segment elevation (NSTEMI) remains to be determined.Patients and MethodsFrom the obseRvatoire des Infarctus de Côte d’Or (RICO) survey, 1541 consecutive patients admitted in intensive care unit with a first NSTEMI were included in the study. Patients who experienced chest pain 1) and 30-day mortality were collected.ResultsAmong the 1541 patients included in the study, 693 patients presented PIA. Baseline clinical characteristics were similar for the 2 groups. There was no significant difference for the GRACE risk score (p=0.942). However, PIA was associated with a lower creatine kinase peak, as a reflect of infarct size (231(109-520) vs. 322(148-844) IU/L, p100 ULN (31% vs. 39%, p<0.001) when compared with the group without PIA. Patients with PIA were admitted with markedly less pre-hospital RCA (0.6% vs. 3.4%, p<0.001) and developed fewer VA (1.6% vs. 4.0%, p=0.008) and heart failure (18.2% vs. 22.6%, p=0.037) during the hospital stay. There was a trend toward a decrease in 30-day death in patients with PIA (4.3% vs 6.1%, p=0.146).ConclusionFrom this large contemporary observational study, PIA is observed in almost 50% of patients admitted for a first NSTEMI. In such patients, PIA is associated with less pre-hospital RCA, and decreased in-hospital VA and heart failure. These findings suggest that identifying lack of PIA in patients admitted for a NSTEMI could help for early risk stratification, in particular for ventricular arrhythmias.