Acute Myocardial Infarction without Warning: Clinical Characteristics and Significance of Preinf arction Angina

Yoshikawa, Tsutomu; Inoue, Soushin; Abe, Sumihisa; Amaki, Makoto; Mitamura, Hideo; Ogawa, Satoshi; Handa, Shunnosuke

doi:10.1159/000175852

Cited by 17 publications

(2 citation statements)

References 18 publications

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“…The extent of a subsequent infarction in that area may be limited in extent by the collateral flow (2)(3)(4). On the other hand, preinfarction effort angina per se identifies patients at higher baseline risk compared to infarct-patients without previous effort angina: on average, such patients are older (4,(8)(9)(10)(11), and have multiple risk factors (9,10,12), more advanced atherosclerosis (2,4,10,12,13) and more frequent previous infarctions (10,12,14). Probably it is for this reason that the long-term outcome of infarct-patients has not always been improved by the presence of antecedent angina, despite the reduction in infarct-size (Table 1).…”

Section: Protection By Collateral Perfusionmentioning

confidence: 99%

“…With this new possible cardioprotective mechanism in mind, it is interesting to look back on previous studies and notice a trend towards faster recanalization of the infarct-related artery (assessed angiographically after 60 or 90 min after the start of thrombolytic therapy or noninvasively by continuous ECG monitoring) in patients with recent antecedent angina compared to those without prodromes (5,6,13,57,58). Indeed, at present, it is not clear to what extent the cardioprotection afforded by prodromal angina in patients with acute myocardial infarction is attributable to improved reperfusion of the infarct-artery or to the other postulated protective mechanisms.…”

Section: Protection By Improved Reperfusionmentioning

confidence: 99%

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Preinfarction Angina and Improved Reperfusion of the Infarct-related Artery

Andreotti¹,

Sciahbasi²,

E³

et al. 1999

Thromb Haemost

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SummaryPreinfarction angina and early reperfusion of the infarct-related artery are major determinants of reduced infarct-size in patients with acute myocardial infarction. The beneficial effects of preinfarction angina on infarct size have been attributed to the development of collateral vessels and/or to post-ischemic myocardial protection. However, recently, a relation has been found between prodromal angina, faster coronary recanalization, and smaller infarcts in patients treated with rt-PA: those with preinfarction angina showed earlier reperfusion (p = 0.006) and a 50% reduction of CKMB-estimated infarct-size (p = 0.009) compared to patients without preinfarction angina. This intriguing observation is consistent with a subsequent observation of higher coronary recanalization rates following thrombolysis in patients with prodromal preinfarction angina compared to patients without antecedent angina. Recent findings in dogs show an enhanced spontaneous lysis of plateletrich coronary thrombi with ischemic preconditioning, which is prevented by adenosine blockade, suggesting an antithrom-botic effect of ischemic metabolites. Understanding the mechanisms responsible for earlier and enhanced coronary recanalization in patients with preinfarction angina may open the way to new reperfusion strategies.A vast number of studies, globally involving ≈17,000 patients with acute myocardial infarction, have unequivocally shown that an infarction preceded by angina evolves into a smaller area of necrosis compared to an infarct not preceded by angina (Table 1) (1). So far, preinfarction angina has been thought to have cardioprotective effects mainly through two mechanisms: collateral perfusion of the infarctzone (2-4), and ischemic preconditioning of the myocardium (5-7). Here we discuss a further mechanism of protection represented by improved reperfusion of the infarct-related artery.

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Section: Protection By Collateral Perfusionmentioning

confidence: 99%

Section: Protection By Improved Reperfusionmentioning

confidence: 99%

Preinfarction Angina and Improved Reperfusion of the Infarct-related Artery

Andreotti¹,

Sciahbasi²,

E³

et al. 1999

Thromb Haemost

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Preinfarction angina prevents left ventricular remodeling in patients treated with thrombolysis for myocardial infarction

NeŠKOVIÉ

Pavlovski

Bojic

et al. 2001

Clinical Cardiology

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summaryBackground: It has been shown that preinfarction angina may have beneficial effects on infarct size and mortality. However, there are no studies that have serially assessed the impact of preinfarction angina on left ventricular (LV) function in a large series of patients.Hypothesis: The study was undertaken to determine whether preinfarction angina (within 7 days before infarction) influences LV remodeling.Methods: In all, 119 consecutive patients with acute myocardial infarction were serially evaluated by 2-dimensional echocardiography (on Days 1,2,3, and 7; at 3 and 6 weeks; and at 3,6. and 12 months following infarction). Left ventricular volumes were determined using Simpson's biplane formula and normalized for body surface area. Wall motion score index and sphericity index were calculated for each study. Coronary angiography was performed before discharge.Results: Preinfarction angina was detected in 39 of I 19 patients. lnitial echocardiographic and clinical data as well as the incidence of patent infarct-related artery and collaterals were similar for patients with and without preinfarction angina. In the subset of thrombolysed patients, patients with preinfarction angina showed decrease of LV end-diastolic and end-sys-

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