Abstract
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). 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. 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. In patients with STEMI treated with primary PCI, pre-infarction UAP has no beneficial clinical effect during hospitalization or during long-term follow-up.
Highlights
Short periods of ischemia have been described in large number of experimental and clinical studies as protecting myocardial cells against following sustained ischemia of the myocardium[1,2,3]
Study population From November 2005 to October 2008 a total of 593 patients with ST elevation myocardial infarction (STEMI) referred for primary percutaneous coronary intervention (PCI) and admitted to the Coronary Care Unit (CCU) of the Internal Cardiology Department of the University Hospital Brno were included in the study
No significant differences in baseline characteristics were found for the two groups excluding the median time from the onset of chest pain to admission to the CCU, which was statistically significantly longer in the unstable angina pectoris (UAP) group
Summary
Short periods of ischemia have been described in large number of experimental and clinical studies as protecting myocardial cells against following sustained ischemia of the myocardium[1,2,3]. Unstable angina pectoris (UAP) preceding myocardial infarction (pre-infarction or prodromal angina pectoris) represents intermittent ischemic periods which could be considered as ischemic preconditioning. It has been demonstrated that pre-infarction UAP resulted in decrease in mortality, acute heart failure, arrhythmias and infarction size[4,5] patients with pre-infarction UAP had better short[6] and long-term[7] outcomes compared to patients with an abrupt onset of myocardial infarction. 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). In patients with STEMI treated with primary PCI, pre-infarction UAP has no beneficial clinical effect during hospitalization or during long-term follow-up
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