Unstable angina pectoris prior to ST elevation myocardial infarction in patients treated with primary percutaneous coronary intervention has no influence on prognosis.
BACKGROUND
Pre-infarction unstable angina pectoris (UAP) can be considered ischemic preconditioning. The aim of this study was to compare short and long term outcomes in patients with or without pre-infarction UAP and ST elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).


METHODS
593 patients with STEMI (388 without and 205 with UAP) were evaluated. Levels of biomarkers (troponin I, BNP, NT-ProBNP, neopterin, endoglin and pentraxin-3) at hospital admission and 24 h after STEMI onset were assessed. Echocardiography was undertaken on the fourth day after MI and after 12 months. The median follow-up was 37 months.


RESULTS
We found no significant differences in sex, age or risk factors for atherosclerosis between the UAP and non-UAP group. As the median time from the onset of chest pain to admission was significantly longer in the UAP group (228 min vs 258 min; P=0.009), we used a propensity score to obtain comparable matched groups for use in further analyses. The levels of NT-proBNP were significantly higher on admission and after 24 hours in the UAP group. Left ventricular functions according to invasive and echocardiographic parameters were entirely comparable at hospitalization and after 12 months. No differences were found in severity index of acute heart failure during hospitalization. The incidence of major acute coronary events during follow-up was comparable for the groups.


CONCLUSIONS
In patients with STEMI treated with primary PCI, pre-infarction UAP has no beneficial clinical effect during hospitalization or during long-term follow-up.
Department of Internal Cardiology, Medical Faculty, Masaryk University, Brno, Czech Republic.|Hospital Podlesi a.s., Trinec.
Krystyna
K
Kluz
Department of Cardiology, Faculty Hospital Brno.|Department of Cardiovascular Disease, International Clinical Research Center, St. Anne´s University Hospital in Brno.
Jiri
J
Parenica
Department of Internal Cardiology, Medical Faculty, Masaryk University, Brno, Czech Republic.|Department of Cardiology, Faculty Hospital Brno.|Department of Cardiovascular Disease, International Clinical Research Center, St. Anne´s University Hospital in Brno.
Lenka
L
Kubkova
Institute of Biostatistics and Analyses, Masaryk University, Brno.
Simona
S
Littnerova
Department of Internal Cardiology, Medical Faculty, Masaryk University, Brno, Czech Republic.
Josef
J
Tomandl
Department of Cardiology, Faculty Hospital Brno.
Martin
M
Poloczek
Department of Cardiology, Faculty Hospital Brno.
Ondrej
O
Toman
Department of Cardiology, Faculty Hospital Brno.|Hospital Trebic, Trebic-Jejkov.
Martin
M
Tesak
Department of Biochemistry, Faculty Hospital Brno.
Zdenka
Z
Cermakova
Department of Biochemistry, Faculty Hospital Brno.
Jana
J
Gottwaldova
Department of Cardiology, Faculty Hospital Brno.
Jan
J
Manousek
Department of Internal Cardiology, Medical Faculty, Masaryk University, Brno, Czech Republic.
Monika
M
Pavkova Goldbergova
Department of Internal Cardiology, Medical Faculty, Masaryk University, Brno, Czech Republic.|Department of Cardiology, Faculty Hospital Brno.|Department of Cardiovascular Disease, International Clinical Research Center, St. Anne´s University Hospital in Brno.
Jindrich
J
Spinar
Institute of Biostatistics and Analyses, Masaryk University, Brno.
Jiri
J
Jarkovsky
D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000150:complications* / Q000401:mortality; D015415:Biomarkers / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D011446:Prospective Studies; D012008:Recurrence; D020521:Stroke / Q000209:etiology; D061665:Time-to-Treatment
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
STEMI; natriuretic peptides; pre-infarction angina pectoris; primary PCI