Preinfarction angina prevents left ventricular remodeling in patients treated with thrombolysis for myocardial infarction.
BACKGROUND
It has been shown that preinfarction angina may have beneficial effects on infarct size and mortality. However, there are no studies that have serially assessed the impact of preinfarction angina on left ventricular (LV) function in a large series of patients.


OBJECTIVE
The study was undertaken to determine whether preinfarction angina (within 7 days before infarction) influences LV remodeling.


METHODS
In all, 119 consecutive patients with acute myocardial infarction were serially evaluated by 2-dimensional echocardiography (on Days 1, 2, 3, and 7; at 3 and 6 weeks; and at 3, 6, and 12 months following infarction). Left ventricular volumes were determined using Simpson's biplane formula and normalized for body surface area. Wall motion score index and sphericity index were calculated for each study. Coronary angiography was performed before discharge.


RESULTS
Preinfarction angina was detected in 39 of 119 patients. Initial echocardiographic and clinical data as well as the incidence of patent infarct-related artery and collaterals were similar for patients with and without preinfarction angina. In the subset of thrombolysed patients, patients with preinfarction angina showed decrease of LV end-diastolic and end-systolic volumes during the follow-up period (p = 0.033 and p = 0.001, respectively), and improvement of wall motion score index (p < 0.001) and ejection fraction occurred (p = 0.001), without changing of LV shape (p > 0.05); in addition, patients with preinfarction angina had smaller LV volumes and higher ejection fraction than did those without angina, from 3 weeks onward. These favorable effects were not detected in patients not treated with thrombolysis.


CONCLUSIONS
These data indicate that preinfarction angina has an inhibiting effect on long-term LV remodeling in patients who underwent thrombolysis for first acute myocardial infarction. It appears that preinfarction angina has no impact on infarct size and early postinfarction LV function.
Nesković
A N
AN
Dr. Aleksandar D. Popović Cardiovascular Research Center, Dedinje Cardiovascular Institute, Belgrade, Yugoslavia.
Pavlovski
K
K
Bojić
D
D
Popović
Z
Z
Otasević
P
P
Vlahović
A
A
Obradović
V
V
Putniković
B
B
Vasiljević-Pokrajcić
Z
Z
Bojić
M
M
Popović
A D
AD
D000787:Angina Pectoris / Q000503:physiopathology*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000503:physiopathology*; D013300:Streptokinase / Q000627:therapeutic use; D013318:Stroke Volume; D015912:Thrombolytic Therapy; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
D005343:Fibrinolytic Agents; D013300:Streptokinase