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Objective: We sought to examine the association between preinfarction angina and a lower risk of right ventricular infarction (RVMI) in patients with first acute inferior myocardial infarction (MI). Methods: One hundred seventy patients who were admitted to cardiac care unit after first acute inferior MI with ST segment elevation and symptom duration < 12 hours and received thrombolysis were studied. Preinfarction angina within 24 hours prior to MI was present in 62 patients (Angina group) whereas the remaining 108 patients (Cohort group) had no chest pain preceding acute MI. The course of the inhospital phase of MI was analyzed. The outcomes studied were presence of RVMI together with inferior MI, major complications and in-hospital mortality. Results: In angina group 15 (24.2%) patients had RVMI, while in control group 70 (64.8%) patients suffered from RVMI (adjusted odds ratio‚0.32%, confidence interval‚0.09 to 0.86 P=0.01). Absence of preinfarction angina was predictor of development of RVMI (P< 0.001)‚ complete atrioventricular block; (P< 0.01)‚ cardiogenic shock (P< 0.001) and in-hospital mortality (P = 0.02). Conclusion: Patients with Preinfarction angina‚ occurring within 24 hours of acute MI‚ have a lower rate of right ventricular infarction and better in-hospital outcome than patient without antecedent angina. These results may be attributed to the protective effects of ischemic preconditioning. (Rawal Med J 2008;33:43-46).