Early post-infarction angina. Ischemia at a distance and ischemia in the infarct zone.

We studied two forms of post-infarction angina: ischemia at a distance (angina with new electrocardiographic changes distant from the acute infarct) and ischemia in the infarct zone (angina with new electrocardiographic changes limited to the leads originally involved by the acute infarct). Seventy patients with early post-infarction angina were followed for an average of six months; 43 had ischemia at a distance, and 27 had ischemia in the infarct zone. Mortality in the entire group was 56 per cent, but it was 72 per cent (31 of 43 patients) among those with ischemia at a distance and 33 per cent (nine of 27) among those with ischemia in the infarct zone (P less than 0.005). Post-infarction angina identifies patients with high mortality; among such patients, ischemia at a distance may represent an especially high-risk subset of patients with large areas of viable but jeopardized myocardium who could benefit from aggressive intervention.