title: Relation between the timing of the last preinfarction angina and microvascular reperfusion in patients with recanalized acute myocardial infarction.
abstract: In patients with recanalized acute myocardial infarction (AMI), the relation between the timing of preinfarction angina (PA) and microvascular reperfusion remains unclear. A total of 186 patients (114 with anterior and 72 with inferior AMI) who had total occlusion and TIMI 3 recanalization < or = 6 hours from the onset of AMI were divided into 4 groups according to the time interval between the last episode of PA and the onset of AMI: < or = 2 hours (group A, n = 52); 2 to 48 hours (group B, n = 43), > or = 48 hours (group C, n = 33), and no PA (group D, n = 58). The angiographic myocardial blush grade, a marker of microvascular reperfusion, was retrospectively assessed immediately after recanalization. There were no differences in baseline characteristics, except for sex among the 4 groups. Myocardial blush grade 3 was more frequent (42% vs 21%, 9%, and 14%) and peak creatine kinase was lower (2659 vs 3455, 4422, and 4622 mU/mL) in group A than in groups B, C, and D (all P < 0.05). Multivariate analysis showed that PA occurring < or = 2 hours before AMI (OR 3.88, P < 0.05), a smaller summed ST-segment elevation before recanalization (OR 0.84, P < 0.01), earlier time to recanalization (OR 0.52, P < 0.05), and interior AMI (OR 4.87, P < 0.05) were independently associated with adequate microvascular reperfusion. We conclude that PA < or = 2 hours before the onset of AMI is independently associated with adequate microvascular reperfusion after recanalization in patients with AMI.
authors.affiliation: Division of Cardiology, Yokohama City University Medical Center, Japan.
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Saito
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kimura
authors.forename: Masami
authors.initials: M
authors.lastname: Kosuge
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Ishikawa
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Endo
authors.forename: Teruyasu
authors.initials: T
authors.lastname: Sugano
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Hibi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nakagawa
authors.forename: Tomoyori
authors.initials: T
authors.lastname: Nakatogawa
authors.forename: Jun
authors.initials: J
authors.lastname: Okuda
authors.forename: Osamu
authors.initials: O
authors.lastname: Tochikubo
authors.forename: Satoshi
authors.initials: S
authors.lastname: Umemura
mesh_terms: D000328:Adult; D000368:Aged; D000789:Angina, Unstable; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D015425:Myocardial Reperfusion; D009204:Myocardial Revascularization; D012189:Retrospective Studies; D013995:Time; D016277:Ventricular Function, Left / Q000502:physiology