Prodromal angina reduces infarcted mass less in interventionally reperfused than in thrombolysed myocardial infarction.
There is a lot of evidence that angina during the 24-48 h before a reperfused myocardial infarction improves the evolution of the patients. However, there are studies that failed to demonstrate this protective effect of preinfarction angina in an interventional reperfusion setting.


OBJECTIVE
To compare the effect of preinfarction angina (PIA) on inhospital evolution of thrombolysis vs. interventionally reperfused acute myocardial infarction (AMI).


METHODS
There were prospectively studied 133 consecutive AMI patients, eligible for reperfusion (thrombolysis or interventional). History of PIA under 48 hours was obtained. Evolution of AMI was evaluated considering the following end-points: the ratio between the number of ECG leads with final pathologic Q wave and the number of leads with initial ST elevation, CK-MB values, separate and composite incidence of death, heart failure, shock and incidence of serious arrhythmia (sustained VT or ventricular fibrillation).


RESULTS
ECG ratio was lower in patients with PIA (0.511 +/- 0.281 vs. 0.646 +/- 0.274, p=0.02) in thrombolysed patients, but it was higher in interventionally reperfused patients (0.740 +/- 0.418 vs. 0.554 +/- 0.295 p=0.11). CK-MB values were lowered by PIA in thrombolysed AMI (122 +/- 74 vs. 190 +/- 89, p=0.0003), but they were not in the interventional group. Clinical end-points were slightly less frequent in patients with PIA, in both reperfusion groups, but not statistically significant. Major arrhythmia occurred less frequently in interventionally reperfused patients with PIA (9.5% vs. 31.6%, p=0.12).


CONCLUSIONS
Preinfarction angina under 48 hours significantly reduces infarcted mass (measured by ECG and enzymes) in thrombolysed patients, but not in the interventional group. However, PIA reduced arrhythmic end-point in interventional setting.
Ober
M C
MC
First Medical Clinic, Angiographic Laboratory, Romania. mober@pcnet.ro
Ober
Camelia
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Hagău
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A
Moţ
St
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Iancu
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Literat
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Căpâlneanu
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D000368:Aged; D000789:Angina, Unstable / Q000473:pathology* / Q000503:physiopathology; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D052279:Creatine Kinase, MB Form / Q000097:blood; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000201:enzymology / Q000473:pathology* / Q000503:physiopathology / Q000628:therapy*; D009206:Myocardium / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies; D015912:Thrombolytic Therapy
D015415:Biomarkers; D052279:Creatine Kinase, MB Form