What is the clinical evidence from this study?

Study design: Cohort. Population: Myocardial infarction (n=503). Intervention: Antecedent angina within 48 hours vs. No antecedent angina. Primary outcome: Combined end points (in-hospital death and congestive heart failure or shock) in adult patients (p=<0.0003).

What does this research mean for the field?

Antecedent angina within 48 hours of myocardial infarction confers cardioprotection against adverse in-hospital outcomes in adults under 65 years, but this protective preconditioning effect is lost in elderly patients. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To determine whether angina occurring within 48 hours before myocardial infarction provides cardioprotection against adverse in-hospital outcomes in adult versus elderly patients.

August 18, 2026Journal of the American College of CardiologyOpen Access

Angina-Induced Protection Against Myocardial Infarction in Adult and Elderly Patients: A Loss of Preconditioning Mechanism in the Aging Heart?

Q: What are the key findings of this study?

Antecedent angina within 48 hours of myocardial infarction reduced in-hospital death, heart failure, or shock in adults <65 years (5.9% vs 20.7%, p<0.0003) but not in elderly patients.

Q: What does this research mean for the field?

Antecedent angina within 48 hours of myocardial infarction confers cardioprotection against adverse in-hospital outcomes in adults under 65 years, but this protective preconditioning effect is lost in elderly patients. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

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Key result

Antecedent angina before MI is linked to ~71% fewer major in-hospital events in adults <65.

P<0.0003
n=503

Why the study?

Pre-infarction angina confers cardioprotection in adult patients, but whether it provides similar protection in aged patients was unknown.

Does antecedent angina within 48 hours of myocardial infarction improve in-hospital outcomes in adult and elderly patients?

Population

Adult (< 65 years old, n = 293) and elderly (>= 65 years old, n = 210) myocardial infarction patients

Comparison

Antecedent angina within 48 h of myocardial infarction vs no previous angina

Design

Retrospective study

Follow-up

In-hospital

Authors

PAPasquale AbeteHeart Failure / Cardiomyopathy NFNicola FerraraUniversità Cattolica del Sacro Cuore FCFrancesco CacciatoreHeart Failure / Cardiomyopathy

Discussion

Member takes

Implication

Preinfarction angina may protect adults but not elderly; leaves open whether aging abolishes preconditioning benefit in humans.

Key Points

To determine whether angina occurring within 48 hours before myocardial infarction provides cardioprotection against adverse in-hospital outcomes in adult versus elderly patients.
Retrospectively analyzed in-hospital outcomes in adult (<65 years old, n=293) and elderly (≥65 years old, n=210) patients admitted with acute myocardial infarction.
Evaluated the occurrence of antecedent angina within 48 hours before infarction and assessed its impact on in-hospital death, heart failure, and cardiogenic shock using logistic regression.
In adult patients (<65 years), prior angina significantly reduced in-hospital mortality (2.6% vs. 10%, p < 0.01), congestive heart failure or shock (3.3% vs. 10.7%, p < 0.02), and combined endpoints (5.9% vs. 20.7%, p < 0.0003).
In elderly patients (≥65 years), prior angina conferred no significant benefit for in-hospital mortality (15.2% with angina vs. 14.4% without, p = 0.97), heart failure or shock (11.9% vs. 11.0%, p = 0.99), or combined endpoints (27.1% vs. 25.4%, p = 0.89).

Study Design

Type

Cohort (n=503)

Structured PICO

Does antecedent angina within 48 hours of myocardial infarction improve in-hospital outcomes in adult and elderly patients?

Population

503 patients with acute myocardial infarction, stratified into adult (<65 years, n=293) and elderly (≥65 years, n=210) groups to assess the effect of antecedent angina.

Exposure

Antecedent angina within 48 hours of myocardial infarction

Comparator

Absence of previous angina before acute myocardial infarction

Outcome

In-hospital outcomes including in-hospital death, congestive heart failure or shock, and a combined endpoint of these eventscomposite

Main Result

Absolute Event Rate: 5.9% vs 20.7%

p-value: p=<0.0003

Antecedent angina provides ischemic preconditioning and protects against adverse in-hospital outcomes in adult patients with myocardial infarction, but this protective mechanism appears to be lost in elderly patients.

Cite This Study

Abete et al. (1997) conducted a cohort in Myocardial infarction (n=503). Antecedent angina within 48 hours vs. No antecedent angina was evaluated on Combined end points (in-hospital death and congestive heart failure or shock) in adult patients (p=<0.0003). Antecedent angina within 48 hours of myocardial infarction reduced in-hospital death, heart failure, or shock in adults <65 years (5.9% vs 20.7%, p<0.0003) but not in elderly patients.

synapsesocial.com/papers/6a8477eaf54da20a1578d64f https://doi.org/10.1016/s0735-1097(97)00256-8

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Angina-Induced Protection Against Myocardial Infarction in Adult and Elderly Patients: A Loss of Preconditioning Mechanism in the Aging Heart?

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Angina-Induced Protection Against Myocardial Infarction in Adult and Elderly Patients: A Loss of Preconditioning Mechanism in the Aging Heart?

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider