title: Protective effect of pre-infarction angina on microvascular obstruction after primary percutaneous coronary intervention is blunted in humans by cardiovascular risk factors.
abstract: BACKGROUND
  Pre-infarction angina (PIA) has been shown to reduce the microvascular obstruction (MVO) rate in patients with ST-segment elevation myocardial infarction (STEMI). We sought to evaluate the potential modulator role of cardiovascular risk factors (CRFs) on this protective effect.
  
  
  RESULTS
  Two hundred patients with STEMI were enrolled. PIA was defined as typical chest pain within the 48 h preceding STEMI onset. Angiographic MVO was defined as TIMI flow grade <2 or TIMI flow 3 with myocardial blush grade <2; electrocardiographic (ECG) MVO was defined as ST-segment elevation resolution <70%. Common CRFs were collected. In the absence of hypertension, both angiographic and ECG MVO rates were lower in patients with PIA as compared with those without, whereas, in the presence of hypertension, they were similar in both study groups (P for interaction=0.01 and P=0.014, respectively). Among nonsmokers, angiographic and ECG MVO rates were lower in patients with PIA as compared with those without, whereas within smokers, they were similar in both study groups (P for interaction=0.037 and P=0.037, respectively). In the absence of dyslipidemia, the angiographic and ECG MVO rates were lower in patients with PIA as compared with those without, whereas within dyslipidemic patients, they were similar in both study groups (P for interaction=0.012 and P=0.04, respectively).
  
  
  CONCLUSIONS
  The protective effect of PIA on MVO is blunted by CRFs.
authors.affiliation: Institute of Cardiology, Catholic University of the Sacred Heart.
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Niccoli
authors.forename: Giancarla
authors.initials: G
authors.lastname: Scalone
authors.forename: Nicola
authors.initials: N
authors.lastname: Cosentino
authors.forename: Alessandro
authors.initials: A
authors.lastname: Fabretti
authors.forename: Alessandro Mandurino
authors.initials: AM
authors.lastname: Mirizzi
authors.forename: Mario
authors.initials: M
authors.lastname: Gramegna
authors.forename: Mario
authors.initials: M
authors.lastname: Panebianco
authors.forename: Marco
authors.initials: M
authors.lastname: Roberto
authors.forename: Filippo
authors.initials: F
authors.lastname: Crea
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D017566:Microvascular Angina / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D012307:Risk Factors