[The role of ischemic preconditioning in acute myocardial infarction].
BACKGROUND
Ischemic preconditioning is a phenomenon in which brief episodes of ischemia and reperfusion increase myocardial tolerance and substantially reduce the infarction size.


METHODS
Two patients with acute left anterior descending artery occlusion received fibrinolytic therapy within 6 hours of symptom onset, but nevertheless developed myocardial infarctions of different size. The first patient, without a history of preinfarction angina, developed a large anterior infarction, because there was no time for ischemic preconditioning or development of coronary collateral vessels. The second patient, with a 4-day history of preinfarction angina, had a more favorable outcome - he developed apical necrosis, with greater myocardial viability in the infarct-related area.


CONCLUSIONS
The beneficial effects of angina occurring 24-48h before infarction are resulting from ischemic preconditioning, which reduces cardiac mortality, infarct size and occurrence of life-threatening ventricular arrhythmias.
Ristić
Andelka
A
Vojnomedicinska akademija, Beograd, Klinika za urgentnu internu medicinu.
Damjanović
Milorad
M
Baskot
Branislav
B
Rafaelovski
Sasa
S
D000328:Adult; D000789:Angina, Unstable / Q000628:therapy*; D006801:Humans; D019157:Ischemic Preconditioning, Myocardial; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015912:Thrombolytic Therapy