Abstract 14106: Change in Angina Symptom Status After Acute Myocardial Infarction and its Association With Readmission Risk: An Analysis of the TRIUMPH Registry

Background: A primary treatment goal for patients with acute myocardial infarction (MI) is the management of angina. The prognostic significance of angina after acute MI, for both patients with angina prior to MI and those with no prior angina, has not been examined. Methods: We studied 2533 patients with acute MI enrolled at 24 hospitals in the TRIUMPH registry who had angina symptoms assessed using the Seattle Angina Questionnaire. We examined baseline angina during the four weeks preceding MI (assessed at initial hospitalization) and angina at 30 days after MI. Patients were grouped by change in angina status: no angina (-/-), resolved angina (+/-), developed angina (-/+), and persistent angina (+/+). A proportional hazards model, adjusting for significant clinical and treatment variables, assessed the association of each group with readmission risk over the subsequent 12 months. Results: Overall, 1293 patients (51%) had angina at baseline and 849 (34%) had angina 30 days after MI. A total of 344 (14%) patients developed new angina, 505 (22%) had persistent angina, and angina resolved for 788 (31%). Revascularization rates were lower in patients with developed (77%) or persistent angina (66%) compared with those with resolved (82%) or no angina (78%). Readmission-free survival at 12 months was similar between patients with resolved angina and those with no angina, and was higher compared with patients who developed angina or had persistent angina (Figure). After multivariable adjustment, risks of readmission remained significantly higher for patients who developed angina (HR 1.42, 95% CI 1.10-1.84) or had persistent angina (HR 1.36, 95% CI 1.07-1.84) compared with those with no angina. Conclusions: Patients with new or persistent angina 30 days after an acute MI are more likely to be readmitted. Prioritizing management of post-MI angina is a potential means of reducing readmission risk.