Carpeggiani C, et al. - Researchers assessed the long-term prognosis of angina pectoris (AP) vs unheralded myocardial infarction (MI) as alternative first clinical presentations of ischemic heart disease (IHD). They also determined the impact of sex on prognosis. They included 2,272 consecutive patients (age < 70 years; known coronary anatomy; at least 10-year follow-up) with unheralded MI or AP as first manifestation of IHD. The end-points included fatal and non-fatal MI, all-cause, and cardiac deaths. They observed a more adverse prognosis in patients who had MI vs AP as first clinical manifestation of IHD. Findings revealed that future MI occurrence was rarely seen in AP. Males were had more MI vs AP, while females were mainly affected by AP.