What does this research mean for the field?

Patients with acute myocardial infarction who had pre-angina experienced significantly lower 30-day cardiovascular mortality, especially in STEMI cases, compared to those without pre-angina. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

February 8, 2026

Pre-myocardial infarction symptom and short- and long-term cardiovascular mortality among acute myocardial infarction patients

Key Result

Absence of pre-angina before AMI was linked to significantly higher 30-day and long-term cardiovascular mortality in STEMI patients, but not NSTEMI patients.

Key Points

To assess the influence of pre-angina on short- and long-term cardiovascular mortality in acute myocardial infarction patients.
Retrospective analysis of consecutive AMI patients from 1999 to 2015
Groups divided based on presence or absence of pre-angina before AMI onset
Primary endpoint was cardiovascular death up to 5 years
51.0% of 2,159 AMI patients had pre-angina
30-day cardiovascular mortality was higher in patients without pre-angina
Significantly higher cardiovascular mortality after 30 days in STEMI patients without pre-angina
No significant difference in cumulative cardiovascular death between groups in NSTEMI population

Structured PICO

Does the presence of pre-angina improve short- and long-term cardiovascular mortality in acute myocardial infarction patients?

Population

2,159 consecutive acute myocardial infarction (AMI) patients who underwent primary percutaneous intervention between 1999 and 2015.

Intervention

Presence of angina prior to the onset of AMI (pre-angina).

Comparator

Absence of angina prior to the onset of AMI.

Outcome

Cardiovascular death up-to 5 years.hard clinical

The absence of pre-infarction angina is a negative prognostic marker associated with higher short- and long-term cardiovascular mortality, particularly in patients with STEMI.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Ischemic preconditioning has been associated with smaller infarct size and better clinical outcomes in patients with acute myocardial infarction (AMI). However, the association between pre-angina and long-term clinical outcomes after AMI is uncertain. Purpose The present study aimed to evaluate the impact of pre-angina on long-term cardiovascular outcomes in AMI patients. Methods Consecutive AMI patients who underwent primary percutaneous intervention between 1999 and 2015 were retrospectively analyzed. The primary endpoint was cardiovascular death up-to 5 years. We divided patients into two groups based on whether they had angina prior to the onset of AMI. Results Of the 2,159 AMI patients who had available information of prior symptoms, 1,101 patients (51.0%) had pre-angina. Patients without pre-angina were older and higher rate of ST elevated MI (STEMI). 30-day cardiovascular mortality was significantly higher in patients without pre-angina compared those with pre-angina among both STEMI and NSTEMI patients. Landmark Kaplan-Meier analysis showed that cardiovascular mortality after 30-day was significantly higher in patients without pre-angina among STEMI population, however, the cumulative incidence of cardiovascular death was not significantly different between two groups among NSTEMI population. Conclusions Absence of chest symptoms before AMI is associated with poor prognosis. Especially for STEMI patients, it is associated with both short- and long-term cardiovascular mortality.30-day cardiovascular mortality Land-mark analysis for cardiovascular de

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