This Article Full Text (PDF) References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Google Scholar Citing Articles via Scopus Google Scholar Articles by Tomoda, H. Articles by Aoki, N. Search for Related Content PubMed PubMed Citation Articles by Tomoda, H. Articles by Aoki, N. Social Bookmarking                         What's this?

Coronary Blood Flow in Evolving Myocardial Infarction Preceded by Preinfarction Angina: A Critical Reevaluation of Preconditioning Effects in Clinical Cases

Department of Cardiology, Tokai University Hospital, Yamato Seiwa Hospital, Kanagawa, Japan.

Naoto Aoki, MD

Department of Cardiology, Yamato Seiwa Hospital, Kanagawa, Japan.

This study was undertaken to reevaluate the protective effects of preinfarction (pre-MI) angina in acute MI. The mechanisms involved in the apparent protective effects of pre-MI angina have been presumed to be preconditioning effects as defined by experimental studies. The phenom enon, has not, however, been observed in diabetic and/or elderly patients or in those treated by primary percutaneous coronary intervention (PCI). A total of 202 patients with anterior wall MI without a history of MI who underwent primary PCI with coronary balloon dilation and stenting (rate: 50%) < 6 hours after onset were studied. Patients included 59 with pre-MI angina (group 1) and 143 without pre-MI angina (group 2). The infarct-related coronary artery was patent on admission in 46% of group 1 and 31 % of group 2 (p = 0.045). Thrombolysis in Myocardial Infarction (TIMI) 1-2 flow was significantly more frequent in group 1 (29%) than in group 2 (11%, p = 0.005) on admission. Among risk factors, clinical background, coronary anatomy, and clinical outcome, the only significant predictor of pre-MI angina was a patent infarct-related coronary artery on admission (odds ratio: 2.39, p=0.015). There was no signif icant difference in left ventricular ejection fraction, peak creatine kinase, or the incidences of heart failure and in-hospital/follow-up deaths between these groups. In conclusion, the findings suggest that the protective effects reported in MI with pre-MI angina treated by thrombolysis are due to more fragile thrombotic occlusion, which can be more easily recanalized by throm bolysis, whereas the beneficial effects are not evident in those treated by primary PCI.

Angiology, Vol. 55, No. 1, 9-15 (2004)
DOI: 10.1177/000331970405500102


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?