title: Prodromal angina is associated with myocardial salvage in acute ST-segment elevation myocardial infarction.
abstract: OBJECTIVE
  Previous studies have shown that prodromal angina (PA) occurs frequently in acute myocardial infarction (MI) patients. However, the potential benefits of PA on ischaemic myocardial damage remain unknown.
  
  
  RESULTS
  One-hundred and fifty-four patients with acute ST-segment elevation MI successfully treated with primary percutaneous coronary intervention (PPCI) were prospectively evaluated for new-onset PA in the week preceding infarction and other factors known to influence myocardial salvage. Cardiovascular magnetic resonance was performed 8 ± 3 days after MI for the assessment of area-at-risk (AAR), MI size, myocardial haemorrhage (MH), microvascular obstruction (MO), and myocardial salvage index (MSI). Patients with PA (n = 60) compared with those without PA (n = 94) showed similar AAR but significantly smaller MI size leading to larger MSI (0.53 ± 0.27 vs. 0.32 ± 0.26, P < 0.001). Additionally, patients with PA had lower incidence of MH (18 vs. 33%) and MO (22 vs. 46%) than non-PA patients (both P < 0.05). At univariate analysis, higher MSI was associated with new-onset PA, lower myocardial oxygen consumption before PPCI, shorter time-to-PPCI, and higher post-procedural TIMI flow-grade. Neither collateral circulation nor medications administered before PPCI were associated to MSI. After correction for other covariates by multivariate analysis, new-onset PA remained significantly associated with MSI (β-value: 0.352, P < 0.001).
  
  
  CONCLUSIONS
  In acute MI patients, new-onset PA is associated with higher MSI independent of others factors known to influence jeopardized myocardium, as well as with less microvascular damage.
authors.affiliation: Fondazione CNR/Regione Toscana 'G. Monasterio', Via Moruzzi 1, 56124 Pisa, Italy.
authors.forename: Pier Giorgio
authors.initials: PG
authors.lastname: Masci
authors.forename: Daniele
authors.initials: D
authors.lastname: Andreini
authors.forename: Marco
authors.initials: M
authors.lastname: Francone
authors.forename: Erika
authors.initials: E
authors.lastname: Bertella
authors.forename: Laura
authors.initials: L
authors.lastname: De Luca
authors.forename: Michele
authors.initials: M
authors.lastname: Coceani
authors.forename: Saima
authors.initials: S
authors.lastname: Mushtaq
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Mariani
authors.forename: Iacopo
authors.initials: I
authors.lastname: Carbone
authors.forename: Gianluca
authors.initials: G
authors.lastname: Pontone
authors.forename: Luciano
authors.initials: L
authors.lastname: Agati
authors.forename: Jan
authors.initials: J
authors.lastname: Bogaert
authors.forename: Massimo
authors.initials: M
authors.lastname: Lombardi
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D000787:Angina Pectoris / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D015331:Cohort Studies; D015897:Comorbidity; D017023:Coronary Angiography / Q000379:methods; D003326:Coronary Circulation / Q000502:physiology; D004562:Electrocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D062706:Prodromal Symptoms; D011446:Prospective Studies; D018570:Risk Assessment; D016879:Salvage Therapy; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
keywords: Cardioprotection; Myocardial infarction; Prodromal angina