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Background: Angina pectoris (AP) and unheralded myocardial infarction (MI) are considered random clinical equivalents of ischemic heart disease (IHD). Aim of the study was to evaluate the long-term progression of AP as opposed to unheralded MI as alternative first clinical presentations of IHD and the effect of sex on prognosis., Methods: The study included 2272 consecutive patients, 1419 MI and 1353 AP, hospitalized from 1995 to 2007 at CNR Clinical Physiology Institute, Pisa, Italy and followed up to December 2013, who fulfilled the following criteria: unheralded MI or AP as first manifestation of IHD; age < = 70 years; known coronary anatomy; at least 10-year follow-up. Fatal and non fatal MI, all-cause, and cardiac deaths were the end-points., Results: Males were predominant in MI (86%) as compared to AP (77%). Females were predominantly affected by AP (61%, MI 39%), and older than men (61 ± 7 vs 59 ± 8 years, p < 0.001). Coronary stenoses were prevalent in MI. During 115 ± 58 months follow-up, 628 deaths (23%) were observed, including 269 cardiac (43%), and 149 cancer deaths (24%). Long-term prognosis was significantly better in AP than MI group. The lowest prevalence of future MI was recorded in female AP (p < 0.001)., Conclusions: MI as first clinical manifestation of IHD implies a more adverse prognosis than AP; future MI is a rare event in AP; sex influences the first presentation of IHD and its course with possible implications for preventive strategy.

Aims: To investigate personality traits and sympatho-vagal modulation of heart rate variability (HRV) during acute myocardial infarction (AMI), assessing their relationships and their long-term prognostic value., Methods and Results: Psychological traits and 24 h HRV were prospectively investigated in 246 patients at discharge of an AMI. Patients were followed-up to 8 years for the occurrence of cardiac death and non-fatal reinfarction. Low coping and anxiety traits associated with reduced HRV characterized the study population. At univariate analysis, low emotional sensitivity and insecurity, relative tachycardia, reduced high frequency (HF), and low frequency power and pNN50 were predictive of cardiac death at 8-year follow-up. At multivariable analysis, low emotional sensitivity and low HF power remained predictive, with a relative risk of 4.18 (P=0.003) and 2.76 (P=0.007), respectively; also the type of infarction (Q vs. non-Q) and hospital length of stay were independent predictive variables., Conclusion: Anxiety and emotional sensitivity were significant predictors of 8-year cardiac mortality after AMI. Reduced HF power, a recognized marker of vagal withdrawal, increased the risk.

Background: Depressed heart rate variability at acute myocardial infarction discharge is associated with poor long-term prognosis. However, its early (<48 h) predictive value has not been extensively investigated. Aim of this Multicenter Italian Study was to investigate, during acute myocardial infarction, in-hospital prognostic value of heart rate variability and its short-term evolution., Methods: Twenty-four hour ECG monitoring was prospectively obtained on admission in 413 patients with new-onset acute myocardial infarction and repeated in 349 at discharge. Heart rate variability statistical and frequency domain indices, peak creatine kinase, echocardiographic wall motion score index and risk factors were obtained. The occurrence of cardiac death and resuscitated ventricular fibrillation were the primary end-points; cardiogenic shock, ventricular tachycardia, post-infarction angina and heart failure the secondary end-points., Results: At admission, a marked reduction in heart rate variability indices was evident. Nine patients died during hospitalization and 13 were resuscitated from ventricular fibrillation. Secondary endpoints occurred in other 91 patients. At univariate analysis, low frequencies (LF), mean time interval between consecutive heart beats (RR), wall motion score index and family history of ischemic heart disease were predictive of combined primary and secondary end-points. At multivariate analysis, only LF and family history were predictive with a relative risk of 2.01 and 1.84, respectively (P<0.003). In survivors, heart rate variability indices significantly increased during hospitalization, still remaining below reference values., Conclusions: A depressed heart rate variability was present in the early phase of infarction and improved at discharge. LF power was an independent predictor of the combined unfavorable short-term events.

Investigates the relationships between personality and behavioral responses in patients with acute myocardial infarction. Development of the PSY inventory for assessing behavioral characteristics; Correlations of the PSY inventory with the Cattell 16 PF questionnaire.