Document Detail


Preinfarction angina reduces infarct size in ST-elevation myocardial infarction treated with percutaneous coronary intervention.
MedLine Citation:
PMID:  23339840     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Preinfarction angina may act as a clinical surrogate of ischemic preconditioning that may reduce infarct size and improve mortality in the setting of thrombolytic therapy for ST-elevation myocardial infarction. However, the benefits of preinfarction angina in the setting of primary percutaneous coronary intervention with stenting is inconclusive because of the greater achievement of infarct artery patency and speed of reperfusion.
METHODS AND RESULTS: To identify a homogeneous population, we performed a retrospective analysis of 1031 patients admitted with a first ST-elevation myocardial infarction with ischemic times between 1 and 6 hours who received primary percutaneous coronary intervention. We identified 245 patients who had occluded arteries on presentation, of which 79 patients had documented preinfarction angina defined as chest pain within 24 hours of infarction. Infarct size was measured as the peak creatine kinase level, a metric supported in a subgroup by late enhancement on cardiac magnetic resonance imaging. Patients with preinfarction angina (n=79) had a 50% reduction in infarct size compared with those patients without preinfarction angina (n=166) by both peak creatine kinase (1094±75 IU/L versus 2270±102 IU/L; P<0.0001) and creatine kinase area under curve (18 420±18 941 versus 36 810±21 741 IU/h per liter; P<0.0001) despite having identical ischemic times (185±8 minutes versus 181±5 minutes; P=0.67) and angiographic area at risk (24.1±1.2% versus 25.3±0.9%; P=0.43). There was an absolute 4% improvement in left ventricular ejection fraction before discharge in those patients with preinfarction angina (P<0.02).
CONCLUSIONS: The occurrence of preinfarction angina is associated with significant myocardial protection in the setting of primary percutaneous coronary intervention with stenting during ST-elevation myocardial infarction. Because preinfarction angina is relatively common, it is important that these patients be identified in clinical trials investigating therapies designed to reduce reperfusion injury and infarct size.
Authors:
Ronald Reiter; Timothy D Henry; Jay H Traverse
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2013-01-22
Journal Detail:
Title:  Circulation. Cardiovascular interventions     Volume:  6     ISSN:  1941-7632     ISO Abbreviation:  Circ Cardiovasc Interv     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-02-20     Completed Date:  2013-08-12     Revised Date:  2014-02-04    
Medline Journal Info:
Nlm Unique ID:  101499602     Medline TA:  Circ Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  52-8     Citation Subset:  IM    
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MeSH Terms
Descriptor/Qualifier:
Aged
Angina, Unstable / pathology*,  physiopathology
Coronary Angiography
Electrocardiography
Female
Follow-Up Studies
Heart Function Tests
Humans
Male
Middle Aged
Myocardial Infarction / pathology*,  physiopathology
Myocardial Stunning / pathology*
Percutaneous Coronary Intervention*
Retrospective Studies
Grant Support
ID/Acronym/Agency:
1-RO1-HL103927/HL/NHLBI NIH HHS; R01 HL103927/HL/NHLBI NIH HHS
Comments/Corrections

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