Angina alone was associated with slightly lower risks of all-cause (HR 0.73; 95% CI 0.55-0.98) and IHD-related death (HR 0.65; 95% CI 0.44-0.98) compared to previous AMI or revascularisation.
Cohort (n=1,609)
Yes
Does a diagnosis of angina alone confer a more benign prognosis for mortality and cardiac outcomes compared to a history of AMI or revascularisation in adults with ischaemic heart disease?
Patients with angina alone have a similar prognosis for death or cardiac outcomes compared to those with previous AMI or revascularisation, but experience poorer physical health status, highlighting the clinical importance of angina in primary care.
Hazard Ratio: 0.73 (95% CI 0.55–0.98)
p-value: p=<0.05
AIM: To compare prognosis for patients with a diagnosis of angina alone to patients postacute myocardial infarction (AMI) and/or revascularisation and/or angina. DESIGN: Community-based retrospective cohort study. SETTING: A random selection of 37 Irish general practices. PARTICIPANTS: 1,609 adults with ischaemic heart disease (IHD) identified in 2000/1. INTERVENTION: Medical records searches and postal questionnaires in 2000/1 and 2005/6. OUTCOME MEASURES: Primary: all-cause and IHD-related mortality. Secondary: acute myocardial infarction (AMI), cardiac artery bypass grafting (CABG) and percutaneous transluminal coronary angioplasty (PTCA); physical and mental health status as measured by SF36 and SF12; process of care measurements and behavioural risk factor outcomes. RESULTS: Compared with patients with previous AMI and/or revascularisation, patients with angina alone had slightly lower risks of all-cause and IHD-related death: however, although hazard ratios of 0.73 (95% CI 0.55 to 0.98) and 0.65 (95% CI 0.44 to 0.98), respectively, were significant at the p<0.05 level, they were not significant at the p<0.01 level currently suggested as appropriate in observational research. Proportional hazards models identified no statistically significant differences in adjusted risks of subsequent AMI, CABG or PTCA between patients with angina-alone and those with other IHD. Over the 4.5-year follow-up, physical functioning was consistently lower among those with angina alone, and the extent to which physical functioning was increasingly impaired was slightly greater. CONCLUSIONS: Prognosis to death or cardiac outcomes for patients with angina alone was similar to those with previous AMI and/or revascularisation, while health status was poorer. The clinical importance of angina should not be underestimated in primary care. Further descriptive research is needed among representative community cohorts of people with angina.
Buckley et al. (Thu,) conducted a cohort in Ischaemic heart disease (IHD) (n=1,609). Angina alone vs. Previous AMI and/or revascularisation was evaluated on All-cause mortality (HR 0.73, 95% CI 0.55-0.98, p=<0.05). Angina alone was associated with slightly lower risks of all-cause (HR 0.73; 95% CI 0.55-0.98) and IHD-related death (HR 0.65; 95% CI 0.44-0.98) compared to previous AMI or revascularisation.