1. Preinfarction Angina Reduces Infarct Size in ST-Elevation Myocardial Infarction Treated With Percutaneous Coronary Intervention
- Author
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Jay H. Traverse, Ronald Reiter, and Timothy D. Henry
- Subjects
Male ,medicine.medical_specialty ,medicine.medical_treatment ,Population ,Myocardial Infarction ,Infarction ,Coronary Angiography ,Chest pain ,Article ,Angina ,Electrocardiography ,Percutaneous Coronary Intervention ,Internal medicine ,medicine ,Humans ,Angina, Unstable ,cardiovascular diseases ,Myocardial infarction ,education ,Aged ,Retrospective Studies ,Myocardial Stunning ,education.field_of_study ,medicine.diagnostic_test ,business.industry ,Percutaneous coronary intervention ,Middle Aged ,medicine.disease ,Heart Function Tests ,Cardiology ,Ischemic preconditioning ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,business ,Follow-Up Studies - Abstract
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 P 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 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.
- Published
- 2013
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