[Causes of Angina Pectoris in Survivors of Myocardial Infarction and the Role of Optimization of Antianginal Therapy. Data of the LINKOR Study E.]

Aim: to analyze causes of attacks of angina pectoris and assess impact of optimization of antianginal therapy on frequency of attacks provoked by various factors.

Material and method: We analyzed diaries of 1226 survivors of myocardial infarction (MI) which occurred within 12months before inclusion in the LINKOR program. Causes of pain and their changes with correction of antianginal therapy were registered during 16 weeks of follow-up.

Results: Participants of the study indicated the following factors as causes of pain: physical exertion (74.9%), psycho-emotional stress (52.6%), meteorological factors (25.9%), elevation of arterial pressure(AP) (18.8%), meals (12.1%), alcohol intake (4.7%), sexual activity (4.4%). Attacks at rest in wakeful state and during sleep were reported by 4.5 and 4.5% of patients, respectively. Prescription of ivabradine and in some cases correction of antihypertensive therapy led to double reduction of the number of patients who indicated physical exertion as a cause of angina. Numbers of patients with attacks caused by meals, AP elevation, psycho-emotional stress, alcohol intake, unfavorable meteorological conditions, and sexual activity decreased by 83.2, 75, 63.3, 63.6, 61.3, and 60.9%, respectively. Numbers of patients with attacks at rest in wakeful state, and at night decreased by 79.8 and 69%, respectively. More than two thirds of patients achieved class I of angina.

Conclusion: Optimization of antianginal therapy directed to lowering or myocardial oxygen consumption leads to reduction of frequency of attacks of pain caused by various triggers. This improves quality of life, increases everyday activity, secures independence, and loweres risk of depression and anxiety.