Preinfarction syndrome-management and follow-up

Abstract

The clinical and electrocardiographic characteristics of the preinfarction or intermediate coronary syndrome, which form a distinct and clinically recognizable pattern in many cases, are summarized in order to facilitate recognition of this important entity in practice. The high incidence (40.6%) of acute myocardial infarction within three months of onset of the intermediate coronary syndrome is stressed to encourage attempts at prophylaxis. Previous attempts of other workers in this direction are briefly reviewed. The protective role of anticoagulant therapy against cardiac infarction in 360 cases of the preinfarction syndrome is investigated. The results of such therapy in 190 patients are compared with those of conservative therapy in 156 patients. Acute myocardial infarction developed within three months in 36.3 per cent of the treated cases and 48.7 per cent of the controls. The mortality of infarcted cases was 26.1 per cent for the treated as against 48.1 per cent for the untreated cases with infarctions. While 18 deaths were reported in the treated group (190 patients) 37 died in the control group (156 patients). The localization or site of myocardial ischemia in the preinfarction phase as well as that of myocardial infarction in the later stages (whenever possible) was delineated in our cases. A relative preponderance of anterior over posterior wall involvement was obvious in each case. A clear-cut and predictable relationship could not be established between the site of the initial ischemia on the one hand and that of the subsequent myocardial infarct on the other. Although the present series is rather small for accurate appraisal of the prophylactic potentialities of anticoagulants, the general impression afforded by the data favors a routine adoption of anticoagulant therapy as a safeguard against myocardial infarction in such cases. In view of our results, the prompt and adequate administration of anticoagulants appears desirable as a routine prophylactic measure against myocardial infarction in cases of the preinfarction syndrome.