Angina pectoris before and after myocardial infarction. Angiographic correlations.

Clinical, hemodynamic, and angiographic data were examined in 97 consecutive patients who underwent catheterization within two years of documented acute transmural myocardial infarction. The patients were divided according to the absence or presence of angina pectoris prior to myocardial infarction (groups 1 and 2). Group 1 had more females, was younger, and had a greater prevalence of one-vessel coronary artery disease. Of the patients surviving the myocardial infarction until hospital discharge, group 1 had fewer cases of postinfarction angina pectoris. The following were not statistically different for the two groups: mean time from infarction to catheterization, location of infarction, heart failure, coronary risk factors, mean left ventricular end-diastolic pressure, and mean ejection fraction. The angiographic significance of angina following infarction was analyzed in the 94 survivors. Patients with angina after infarction had a greater prevalence of two- and three-vessel coronary artery disease compared with patients without angina following infarction. Group 1 patients who had developed angina after infarction also had a greater prevalence of two- and three-vessel disease than patients who had no postinfarction angina. One-vessel disease was found in 82 percent of patients who had no angina before and after infarction. Infarction as the first manifestation of coronary artery disease (group 1) is often associated with one-vessel disease, especially if angina does not appear after infraction. Angina before or after infarction suggests two- and three-vessel disease.