Document Detail

Evidence of ischemic preconditioning in patients experiencing first non-ST-segment elevation myocardial infarction (NSTEMI).
MedLine Citation:
PMID:  14659855     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Several studies have demonstrated the protective effects of preinfarction angina in Q wave myocardial infarction, implicating the role of ischemic preconditioning but this role remains uncertain in patients with a NSTEMI. Subendocardial viability in NSTEMI patients, is thought to be less dependent on collateral circulation and thus more likely to be protected by other mechanisms such as preconditioning. METHODS: We have studied prospectively 40 patients with first NSTEMI and with angiographically proven poor or no collateral development and compared two groups; those with versus those without preinfarction angina. All in-hospital events, such as recurrent angina, congestive heart failure, arrhythmias and reinfarction were recorded. Serum markers of myocardial necrosis (CPK, CPK-MB, AST) and discharge QTc values were estimated. RESULTS: Preconditioned patients suffered less recurrent angina (18 vs. 55% P=0.014), congestive heart failure (0 vs. 22%, P=0.02), arrhythmic events (0 vs. 27%, P=0.008) and had significant smaller values of mean peak CPK (381 +/- 152 vs. 859 +/- 496 I.U./l, P=0.0008), mean peak CPK-MB (45.5 +/- 24.6 vs. 105.2 +/- 87 I.U./l, P=0.01), mean peak AST (59.8 +/- 23.1 vs. 112.4 +/- 64.3 I.U./l, P=0.003) and QTc value at discharge (0.42 +/- 0.03 vs. 0.46 +/- 0.05 s, P=0.005) than patients without preconditioning. Multiple logistic regression analysis confirmed that the absence of preinfarction angina (relative risk 9.10, 95% CI 2.08-40.00, P=0.003) was a significant predictor of in-hospital complications. CONCLUSIONS: Preinfarction angina constitutes a strong clinical correlate to ischemic preconditioning in patients with first NSTEMI, offering serious protection, by improving in-hospital outcome and reducing infarct size.
Christodoulos E Papadopoulos; Haralampos I Karvounis; Ioannis T Gourasas; Georgios E Parharidis; Georgios E Louridas
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  International journal of cardiology     Volume:  92     ISSN:  0167-5273     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2003 Dec 
Date Detail:
Created Date:  2003-12-08     Completed Date:  2004-04-29     Revised Date:  2006-07-12    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  209-17     Citation Subset:  IM    
1st Cardiology Department, Aristotle University of Thessaloniki, AHEPA General Hospital, 1st Kiriakidi St, 54636 Thessaloniki, Greece.
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MeSH Terms
Angina Pectoris / diagnosis,  physiopathology*
Case-Control Studies
Collateral Circulation / physiology
Coronary Circulation / physiology
Ischemic Preconditioning, Myocardial*
Logistic Models
Middle Aged
Myocardial Infarction / physiopathology*
Outcome Assessment (Health Care)
Prospective Studies
Risk Factors

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