Clinical Implication of Persistent Ischemic Chest Pain on Admission in Patients with Late Reperfused Acute Myocardial Infarction.

Abstract

Object Although previous studies reported that late reperfusion might prevent left ventricular dilation after acute myocardial infarction (AMI), implication of persistent ischemic chest pain on admission remains to be investigated. This study was undertaken to assess the implication of persistent ischemic chest pain on in-hospital outcomeand left ventricular function after late reperfused AMI. Methods and Patients Westudied 63 patients with a firstanterior AMIwhounderwent percutaneous coronary intervention 6 to 24 hours (ll.2±4.5 hours) after the onset.Of 63 patients, 48 (76%) had persistent ischemic chest pain on admission.Results Incidence of in-hospital death, reinfarction or congestive heart failure was similar between the 2 groups. Pretreatment left ventricular ejection fraction and end-diastolic volume were similar between the 2 groups. Predischarge angiography was performed at 17±5 days after the onset. Late reperfusion prevented the dilation of left ventricular end-diastolic volume in patients with chest pain (78±12 to 75±17 ml/m2, p=0.15), but did not in those without (75±20 to 93±28 ml/m2, p=0.03). A multivariate analysis revealed that absence of persistent ischemic chest pain was an independent predictor of predischarge left ventricular end-diastolic volume >100 ml/m2 (odds ratio 0.10, p=0.04).Conclusions Our data demonstrated that absence of persistent ischemic chest pain appears to be a simple and reliable marker which predicts left ventricular dilation after late reperfused AMI. (Internal Medicine 41: 920-924, 2002)

Increased Cardiac Mortality in Women Compared with Men in Patients with Acute Myocardial Infarction

“…The reason why being a women by itself is an independent predictor of in-hospital mortality in the patients with UAP is unclear, but may relate to poorer myocardial reserve in the women suggested by diastolic dysfunction (7), and reduced collateral blood flow (16). Moreover, the number of leads with ST depression during an anginal attack (25), absence of persistent ischemic chest pain (26), and lack of microvascular reperfusion following revascularization (27) were independent risk predictors of clinical outcome. Japanese women with ACS present with similar angiographic findings and hemodynamics, but have a higher in-hospital mortality rate than male patients.…”