Pre-infarction angina – a problem more common than one might think. Role of general practitioners according to the 2019 ESC Clinical Practice Guidelines

Abstract

Background and aims: Some patients present with stenocardial pain long before the onset of myocardial infarction. The aim of the study was to evaluate the mean frequency and duration of typical angina pectoris preceding ST-segment elevation myocardial infarction. In addition, the article addresses the role of general practitioners in the diagnosis of patients with suspected coronary artery disease. Material and methods: The study included a total of 120 patients without prior diagnosis of coronary artery disease who were admitted to the invasive cardiology department with ST-segment elevation myocardial infarction. All patients were assessed to determine symptoms preceding myocardial infarction and risk factors for coronary artery disease. In addition, their pre-test probability of disease was estimated. Results: Out of 120 patients, 43 (35.8%) presented with typical angina symptoms preceding myocardial infarction. The median duration of symptoms was 45 days (min 4, max 2,190 days!), and symptoms recurring for ≥2 weeks were found in 35 patients. The estimated pre-test probability of coronary artery disease was >15% in 40 (93%) patients, and the risk factors for coronary artery disease were prevalent. Conclusions: Typical exertional angina preceding myocardial infarction occurred in over 35% of patients. In some of them, it persisted for a number of months. The estimated probability of coronary artery disease in nearly all patients was >15%. Based on the collected data, the authors conclude that there is a need for broadly understood education so as to improve the understanding of typical anginal symptoms. Correct recognition of symptoms by physicians and patients can significantly reduce the incidence of myocardial infarction and, consequently, bring down the prevalence of heart failure, and decrease mortality rates in patients with coronary artery disease.